UIC WAVES Application
Applying for: Year

Name:

Address:
City:
Zip Code:

Home/Campus Phone:

Email:

Do you work? If yes, how many hours per week?

May we contact you at work? If yes, Work Phone:

Please indicate the best way to contact you during regular business hours, 9am-5pm:


PLEASE ANSWER THE FOLLOWING QUESTIONS AS ACCURATELY AND CONCISELY AS POSSIBLE:

1. How did you find out about WAVES?



2. Why are you applying to WAVES?



3. Are you willing AND able to make a time commitment of 10 hrs per semester?


4. WAVES members inform the UIC community about their options to help make informed decisions, in turn modeling healthy behaviors. What do you do to stay healthy in your life?


5. WAVES members are usually helping others, what do you do to help/take care of yourself? For instance, what do you do to relieve stress or just to have fun?


6. WAVES Members are trained to present on 4 distinct topic areas. Please check the topics you are interested in learning.

 Sexual Wellness
Fitness and Nutrition
Alcohol and other Drugs
Stress Management


I affirm that all information submitted on this application is true. I understand that all information submitted will be considered and treated as confidential.


Date


© 2004 The Wellness Center at the University of Illinois at Chicago. All Rights Reserved.