Name:

Year of Graduation:

E-Mail:

Major:

How did you hear about the Peer Alcohol & Drug Education Program?

Why would you like to be a Peer Alcohol & Drug Educator?

Can you give 3-4 hours outside of class monthly throughout each semester?

Please tell us about any experiences — professional, educational, or volunteer, that have prepared you to be a Peer Alcohol & Drug Educator?

Have you taken Drugs, Culture & Society? Please check one:
 No I am currently enrolled I have completed the course

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