Choices Peer Educator Information/Application

*Name:

*Local/Cell Phone: *Email:

*Major: GPA:

*Street Address:

*City: *State: *Zip:

Home address (if different from above)

Street Address:

City: State: Zip:

List any campus and/or community activities/organizations in which you have been involved while at WCSU (or another campus). Include dates involved and your role (chair, member, etc.) for each group.

*Required