Home > Peer Educator Interest Form Peer Educator Interest Form Your Name Gender Age Your Email Phone Are you in school? High SchoolCollege Year In School Do you use social media? Check all that apply. FacebookTwitterInstagramSnapchatPinterestVine Other Would you be interest in participating in any of the following? Check all that apply. Service Learning Team/GroupPeer EducatorYouth Advisory Board Would you be interested in telling your peers about a program like this? YesNo Why or why not? Do you have any special skills that would be an asset to the program? What days and times of the week would you be available to meet? Check all that apply. Monday 4 pm - 6 pm 6 pm - 8 pm Tuesday 4 pm - 6 pm 6 pm - 8 pm Wednesday 4 pm - 6 pm 6 pm - 8 pm Thursday 4 pm - 6 pm 6 pm - 8 pm Friday 4 pm - 6 pm 6 pm - 8 pm Saturday MorningMid-DayAfternoon Sunday MorningMid-DayAfternoon How did you hear about InterAct? Would you like for us to contact you? YesNo If yes, how?
