COMMUNITY SERVICE
OPPORTUNITY
Cabrillo PEERS Team Peer Educator
People Empowering Each other to Realize Success
About the program:
The Cabrillo College PEERS Team (People Empowering Each other to Realize Success) will provide
support and training to active students, club leaders, interns, staff, and faculty with the goal of
enhancing wellness and student success. With a focus on peer support, we facilitate collaboration
between the individuals of the Cabrillo College community. The Cabrillo College PEERS Team works
in collaboration with Student Health Services, the Human Services program and other Student
Services to provide peer counseling and education services. This collaboration will link students with
support services, promote positive decision-making, and empower the students to make a difference
on campus through social and educational initiatives.
Examples of Duties:
Under the direct supervision of Student Health Services:
 Provide direct individual peer education and advising services
 Assist in developing and implementing educational and social programs focused on wellness,
alcohol and other drug issues
 Be well versed in wellness topics, which include: alcohol and other drug use/abuse, nicotine
use, healthy relationships (communication, abstinence, verbal/physical abuse, rape), suicide
prevention and personal health (body image, eating disorders)
 Serve as a College role model and advocate for responsible and healthy lifestyle choices
 Promote and present program services
 Attend all mandatory trainings and meetings
 Follow through with other duties assigned by the Program Supervisor
 Consistently commit at least 6 hours per week including a minimum of 1 hour of supervision
 Commit to service for at least 2 semesters
Qualifications:
 Must be registered and maintain a minimum of 6 units at Cabrillo College while on the Team
 Must have completed at least 12 college semester units
 Must have a cumulative GPA of 3.0 or higher
 Must be a role model for responsible and healthy lifestyle choices and enthusiastic about
educating peers on wellness issues
 Must possess strong verbal communication skills and desire to present information to peers
 Must demonstrate the ability to work with individuals and groups in a leadership capacity
 At least 2 reference forms completed by faculty, counselor, or employment supervisor
Return completed application to Student Health Service, Room 912
Cabrillo PEERS Team Member Application
People Empowering Each other to Realize Success
Name
Last
First
Number
City
Middle
Address
Home Phone
State
Cell Number
Email Address
Zip
Date of Birth
Cabrillo Student ID #:
Gender
Language Fluency Other Than English
Major:
Career Goal
Emergency Contact: Name
Phone
Relationship
INVOLVEMENT RECORD
Name of any organization/activities (on and/or off campus), in which you
have been involved (if more than 3, attached a sheet with this info).
Dates
Position Held
REFERENCES
Name
Title
Phone Number
Please answer the following essay questions. Limit your response to 2 pages total, use doublespaced, 12-point, Times New Roman font. Attach your responses to this application.
1) Explain what draws you to the PEERS Team.
2) Describe the qualities and skills you possess that would make you an effective PEERS
Team member.
3) Describe a difficult situation and how you managed it.
4) Include any additional information that you feel would assist us
Continued on next page
Check-off the following to indicate that you have completed all requirements of this
application:
_____
Attached college transcript confirming you have completed 12 units of college
work. For Cabrillo transcripts you may go on WebAdvisor and print “My Course
History.”
_____
Attached college transcript indicating a cumulative GPA of 3.0. For Cabrillo
transcripts you may go on WebAdvisor and print “My Course History.”
_____
Attached print-out of current semester schedule (printed from WebAdvisor).
_____
Attached 2 PEERS Team Recommendation Forms
_____
Attached answers to the essay questions, maximum 2 pages.
Critical Dates for Spring 2016 Applicants:
Mon, Feb 1st
Applications due in the Student Health Center by 4:00 p.m.
Wed, Feb 3rd
Applicants selected for interview will be notified.
Fri, May 5th
Interviews will take place between 9:00 a.m. and 2:30 p.m.
in 909M (applicants must be available at these times)
Selected PEERS will Participate in the Following Dates:
Fridays
PEERS Meeting from 12 pm to 1 pm Room 915
Club meets weekly. 1st Fri of every month is mandatory.
TBA
Mental Health First Aid training from 8:00 am to 4pm in 913
Fri, Feb 19th
CPE PEERS Training Day, 8:00 am to 5pm in 913
Fri, May 6th
Passport to Wellness Awards Celebration and Fun 5K
Signature
Date
PEERS Team Recommendation Form
The PEERS Team (People Empowering Each other to Realize Success) is a program that provides support and training to
active student leaders, interns, staff, and faculty with the goal of enhancing wellness and student success. With a focus
on peer support, we facilitate collaboration between the individuals of the Cabrillo College community. The Cabrillo
College PEERS Team works in collaboration with Student Health Services, the Human Services program and other
Student Services to provide peer counseling services. This collaboration will link students with support services, promote
positive decision-making, and empower the students to make a difference on campus through social and educational
initiatives.
The student named below, has applied to be a member of the PEERS Team and, if selected, will be working with
students in a peer counseling role as described above. PEERS Team members must:



Serve as a college role model and advocate for responsible and healthy lifestyle choices.
Have very good communication skills.
Demonstrate leadership and a desire to serve Cabrillo College students.
Please answer the following questions about the applicant. Additional comments are appreciated (see #5).
Student Name:
__________________________________________________________________________________________________
Last
First
MI
Recommended by:
__________________________________________________________________________________________________
Last
First
Contact Information
Relationship to student: _________________________________________________How long?____________________
Circle the best response.
Strongly Disagree Neutral Agree Strongly
Disagree
Agree
This student:
1. Has the capability to be successful
on the PEERS Team.
1
2
3
4
5
2. Has the personal qualities to interact
appropriately in sensitive/stressful situations.
1
2
3
4
5
3. Has the communication skills to work
collaboratively.
1
2
3
4
5
4. Has the dedication and passion to make
a 2 semester commitment.
1
2
3
4
5
5. Please feel free to add or attach or further comments on the reverse side of this application.
Signature ________________________________________ Date _______________________
Please return the completed form to the student.
PEERS Team Recommendation Form
The PEERS Team (People Empowering Each other to Realize Success) is a program that provides support and training to
active student leaders, interns, staff, and faculty with the goal of enhancing wellness and student success. With a focus
on peer support, we facilitate collaboration between the individuals of the Cabrillo College community. The Cabrillo
College PEERS Team works in collaboration with Student Health Services, the Human Services program and other
Student Services to provide peer counseling services. This collaboration will link students with support services, promote
positive decision-making, and empower the students to make a difference on campus through social and educational
initiatives.
The student named below, has applied to be a member of the PEERS Team and, if selected, will be working with
students in a peer counseling role as described above. PEERS Team members must:



Serve as a college role model and advocate for responsible and healthy lifestyle choices.
Have very good communication skills.
Demonstrate leadership and a desire to serve Cabrillo College students.
Please answer the following questions about the applicant. Additional comments are appreciated (see #5).
Student Name:
__________________________________________________________________________________________________
Last
First
MI
Recommended by:
__________________________________________________________________________________________________
Last
First
Contact Information
Relationship to student: _________________________________________________How long?____________________
Circle the best response.
Strongly Disagree Neutral Agree Strongly
Disagree
Agree
This student:
1. Has the capability to be successful
on the PEERS Team.
1
2
3
4
5
2. Has the personal qualities to interact
appropriately in sensitive/stressful situations.
1
2
3
4
5
3. Has the communication skills to work
collaboratively.
1
2
3
4
5
4. Has the dedication and passion to make
a 2 semester commitment.
1
2
3
4
5
5. Please feel free to add or attach or further comments on the reverse side of this application.
Signature ________________________________________ Date ________________________
Please return the completed form to the student.
Return this completed application to Student Health Services by the due date indicated above with all
required attachments. Incomplete applications and/or missing attachments will be cause to disqualify
the applicant.
Room 912 is located on the map in the 900 building next cafeteria marked on the Campus map by a
Red Heart