Sensible Nutrition and Body Image Choices
Peer Educators (S.N.A.C.)
APPLICATION FOR PEER EDUCATOR POSITION
Email:
Name:
College phone number:
College
Address:
Permanent phone number:
Permanent
Address:
College Major:
Expected Date of Graduation:
Current GPA:
PERTINENT EMPLOYMENT and SKILLS
Name of Employer
Position
Dates of
Employment
Identify any
Transferable Skills
STUDENT
STUDENT ORGANIZATION
ORGANIZATION INVOLVEMENT:
INVOLVEMENT: Indicate
Indicate any
any student
student organizations
organizations you
you are
are
currently
currently or
or will
will be
be involved
involved in
in during
during the
the upcoming
upcoming semesters.
semesters.
Organization
Organization
Office
Office Held
Held (if
(if any)
any)
Dates
Dates in
in Group
Group
STATEMENT OF INTEREST
Please respond to the following questions on a separate sheet of paper.
1. Why are you interested in becoming a member of S.N.A.C.?
2. What quality/skills will you bring to the group? What skills would you like to develop while
in the group?
3. Have you or someone close to you been affected with any type of eating concern? If so, how
will this affect you in your work as a peer educator?
4. List any time constraints that will affect your involvement in S.N.A.C. (school, job,
volunteer activities, etc.)
5. Describe your level of interest, experience, and skills in each of these categories: promoting
campus events, giving a presentation, designing an awareness event/project.
6. Please include any additional information about yourself that you feel is relevant to joining
S.N.A.C.
REFERENCES
Each candidate must have at least one reference (preferably from an employer, academic
advisor, or other adult who can give an objective overview). It is the applicant's responsibility
to ensure that the enclosed reference form is completed and returned to Room 268, Lafene
Health Center.
Reference Name, Address, and Telephone Number:
Reference Name, Address, and Telephone Number:
Please Note: This completed reference form should be returned by October 1st.
(If you have any questions, call 785.532.6595 or send an email to snac@k-state.edu.)
I hereby certify that all statements and answers set forth on this application are complete and
true. I understand that false statements or omissions will cause the termination of my application.
Signature of Applicant
Date
By placing my initials here (__________), I DO NOT consent to have my photo used in marketing,
educational andpromotional material, to include web site, display and printed brochures, produced
for Lafene Health Center.
10/2008