Healthy Devils Application Form

*Required fields are bold.

*Name:
*Date:
*Local Address (dorm):
*Mailing address (Duke box or apartment):
*Phone Number:
*Cell Number:
*E-mail Address:
*Major:
*Year/Class:

Interview Sign Ups

Please provide 3 different days/times that you are available to meet with a peer education advisor for a 30 minute interview on or before Friday, September 11.

*Day	*Time
Short Answer Questions Please answer the following questions with 3 - 6 sentence responses, or bullet your responses as appropriate.
1. *Describe why you are interested in participating in the peer health education program? What do you feel you could contribute to the program?
2. *List any extracurricular activities you are currently involved in (hobbies, clubs, sports, dorms, fraternity, sorority, etc.) Please note leadership positions held.
3. *Assess your ability to work with your peers in an educational role on health issues in terms of your strengths, weaknesses and past experiences.
4. *What ideas do you have about effective ways to educate your fellow students about health issues? What type of activity would you be most interested in organizing as a peer educator?
5. *When working as a peer educator, you may encounter many types of people. Please tell us about your experience with and perspective on people of different ethnicities, genders, sexual orientations, abilities, religions, lifestyles and values.
6. *What do you do to take care of your health and well-being?
7. *What is your experience with any of the topics that the Healthy Devils address (sexual health, body image, eating disorders, nutrition, mental health issues, alcohol, tobacco and other drug use)? Feel free to include personal experiences, contact with family or friends affected by these issues, volunteer experience, research on these topics, and/or paid work experience.
8. *Please feel free to share other thoughts, feelings, and experiences about yourself that may be pertinent.
9. *Where did you hear about the peer health education program?
Self-care
Students become passionate about health-related topics for many reasons. Many students are inspired not only by personal experiences but also the struggles of friends and loved ones. If you are currently in treatment or have recently completed treatment in the area you are applying for, we encourage you to discuss this endeavor with your provider or with us to determine whether this is an appropriate time for you to engage in peer education activities.
Peer Educator Responsibilities
Please check the box to the left to signify that you have read the responsibilities of a peer educator and agree to meet these expectations if accepted into the Healthy Devils program.
Interest Areas
*Please rank the top three health areas in which you are interested in addressing as a peer educator: Alcohol, Tobacco and other drugs (STAR - Students for Tobacco and Alcohol Reform) Sexual health (DELISH — Duke Educational Leaders In Sexual Health) Disordered eating/body image/nutrition (ESTEEM — Educating Students to Eliminate Eating Misconceptions) Mental Health Issues (MINDS — Mental Issues and Needs of Duke Students)