NeuroDiverse Peer Educator Application

Peer education applications are accepted on a rolling basis. Complete an application to join. We鈥檒l let you know if there are any openings when we receive your application. Otherwise, we will add your name to the waiting list and invite you to interview when openings become available.

Please complete this application and click the 鈥淪ubmit Form鈥� button to forward it to the Counseling Center and Health Center. If you have any questions, please contact Dr. Chris Truong at ctruong AT_TOWSON.

1) Contact Information

E-Mail:

Local Phone:

Local Address:

2) Demographics

First Name:

Middle Initial:

Last Name:

Pronouns (if you would like to disclose):

快活视频ID#:

Date of Birth:

Other

Major:

Expected Graduation Date:

3) Relevant Experiences

To gain an idea of your familiarity with this topic, please list any relevant courses, training, volunteer, and/or work experience related to neurodiversity, disability, and/or diversity and inclusion while at 快活视频or outside of TU.

Please list your on-campus involvement including clubs and activities. For each item on your list, please include: Activity Name, Your Role, Dates involved, and Time commitment per week.

4) Questions Specific to NeuroDiverse Peer Educator Position

The most essential role of a NeuroDiverse Peer Educator is to promote the wellbeing of student body at 快活视频through ongoing peer-to-peer communication on diversity, inclusion, accessibility, and social justice issues. Please discuss why you are interested in becoming a NeuroDiverse Peer Educator.

What do you hope to gain from your experiences as a NeuroDiverse Peer Educator?

What do you think are the most important qualities and skills that a NeuroDiverse Peer Educator should possess?

How did you hear about the NeuroDiverse Peer Education Group?

I hereby, declare that all the information provided on this application form is true to the best of my knowledge. Online Signature (Typing your name is equivalent to an online signature.)

Date: