Center for Academic Excellence

1. Date of Application (mm/dd/yyyy):

2. Name:

3. Mailing Address/Campus Box:

4. City:

5. State:

6. Zip Code:

7. Email Address:

8 . Class Rank (select from menu): Select --->   FR SO JR SR

9. Major:

10. GPA:

11. Please list the courses you are interested in leading a study session for and the grade you earned in the course :

12. Please indicate how many sessions you would like to lead and list your preferred times (see session times below):

No. of Sessions:

Course 1:

Preferred Time 1:

Preferred Time 2:

Preferred Time 3:

Course 2:

Preferred Time 1:

Preferred Time 2:

Preferred Time 3:

Course 3:

Preferred Time 1:

Preferred Time 2:

Preferred Time 3:

Course 4:

Preferred Time 1:

Preferred Time 2:

Preferred Time 3:

Course 5:

Preferred Time 1:

Preferred Time 2:

Preferred Time 3:

13. Please tell us the reasons why you would like to be a peer educator.

14. What skills/strengths do you possess that will help you in this position?