Wellness Center

Applying semester for: Year

Name: name

Local Address:
Street:
City:
Zip Code:

Permanent Address:
Street:
City:
Zip Code:

Home/Campus Phone:
Cell:
Email:

College:
Major:
Year in School:
Expected Graduation date:

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:

1. How did you find out about WAVES?
Orientation/Marketplace
Fun Fair
Wesite
Friend/Faculty/Staff
Current Member
Other(please specify)

2. WAVES requires a commitment of 10 hours per semester. Do you anticipate any conflicts that might make this commitment difficult?

3. What other activities are you involved on in campus? Please list:

4. Why do you want to be a health educator? How will it help your academic and future career goals?

5. What qualities/skills do you have that would make a good peer health educator?

6. What do you feel are key issues that affect college students and what would you do to make an impact on that issue?

7. WAVES members connect with 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?

8. WAVES members are trained in and teach UIC students about alcohol, sexual health, stress management and nutrition. What issues or topics are you interested in?
Sexual Wellness
Fitness and Nutrition
Alcohol
Stress Management

9. Please rate the following as they apply to you.
Scale: 5-Excellent 4-Good 3-Average 2-Needs Work 1-None
Communication Skills
Presentation Skills
Organizational Skills
Written Skills
Time Management
Leadership Skills
Ability to work as a part of a team

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

Signature

WAVES APPLICATION