Peer Education Application Form

Level 2

Applications for Level Two will only be accepted from graduates of the Level One course or another course of equal or greater level. Please submit details of the course you have done with your form, thank you.

Name

Address

Telephone

Mobile Phone Number

E-mail address

 Note: For a prompt response please provide us with your e-mail address

School/College/Occupation

Hobbies & Interests

Next of Kin

Next of Kin Phone Number

Please List your experience of group work or any training similar to Peer Education

Please tell us why you would like to participate in this course.

Please tell us what you think you can bring to the group and the sexual health centre

Thank you for your interest in the Peer Education Programme.