Cross Cultural Health Program Online Application

[UHS Home Page] [International Students] [Cross Cultural Health] [Online Application]

SEARCH All of
Student Affairs

UHS Site:

A to Z - List
of Services

Administrative
Information

Parents/Families

PSU Employees

Sexual Assault
Resources

Students:

	Current Undergrad/ Graduate
	Graduate Assistants/ Fellows
	International
	Students Considering Penn State

Volunteering

CROSS CULTURAL HEALTH PROGRAM (CCHP)

Peer Assistant Application
Please make sure to answer all 22 questions completely.
Upon receipt of your application, the Peer Assistant Coordinator will
call you for an interview.
Feel free to contact the office for further information at 814-863-0461.

PERSONAL INFORMATION:

Name:		E-Mail Address:
Local Address:		Local Phone Number:
Home Address:		Home Phone Number:
Ethnic Background:		Gender:
Current Semester Standing:		Major:


For "other" or "international" please specify ethnicity or country of origin:


What languages (other than English) do you speak?

13. Why do you want to become a volunteer with the Cross Cultural Health Program?
(Please specify the skills and knowledge you wish to obtain).

14. Following completion of the training program, will you be able to make a commitment to be an active volunteer for a minimum of two semesters? Yes No

15. What specific health issues interest you?

16. Please list any relevant course work that you have had.
(ie. HDFS 411 or 420, CNSLR 302, SP COMM 100, etc).

17. Please list any prior student organization, leadership or volunteer experience.
(within the United States and/or elsewhere).

18. How many credits will you be taking this semester?

19. Please list other current extracurricular activities and/or employment obligations.

Activity or Employer:	Hours per week:	Responsibilities:
Activity or Employer:	Hours per week:	Responsibilities:
Activity or Employer:	Hours per week:	Responsibilities:
Activity or Employer:	Hours per week:	Responsibilities:

20. How did you learn about the Peer Assistants of the Cross Cultural Health Program?

21. The basis for the volunteer selection includes both a personal meeting and this application.

Please list the best times for us to contact you, to schedule an interview.

Day:		Time:
Day:		Time:

22. Please list your day and evening phone numbers where you can be reached to schedule an interview.

Day:

Evening