Teen PEP Peer Educator Application

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2023/24

You must be able to meet the following requirements in order to be eligible to apply:

Application Requirements:
-Participation in the group interview to be held when appropriate
-Participation in an individual interview to be scheduled after your application is received

Program Requirements:
-Attendance at a three-day overnight retreat
-Attendance at Teen PEP classes, workshops, and other program events
-Attendance at a one-day, mid-program retreat to be scheduled after the program begins
-Great school attendance
-Signature of your parent or guardian
-Participate in the anonymous state-required entry and exit surveys which include questions about knowledge, attitudes, and behaviors related to sexual health and the Teen PEP curriculum
-Positive attitude at all times, will always "give it your all"

Please provide the date on which you are completing this application: *

YYYY

First Name: *

Last Name: *

Mailing Address: *

Student's Cell Phone Number: *

Parent's Phone Number: *

Student's Email: *

Parent's Email: *

My parent/guardian and I have read and understand the NPS Student Acceptable Use Policy which appropriate use of technology of any kind such as pictures, video, email, etc. (Link is located on page 10 of the Google Slide Presentation) *

Yes. Both I and my parent/guardian consent to to the terms of Newark Public Schools.

No. Both I and my parent/gaurdian do not consent to the terms of Newark Public Schools.

Other:

I have parent/guardian consent to apply to the program and be interviewed (Via online platform and/or when we return to school) *

Yes. I have full permission to be interviewed via an online platform and in school.

No. I do NOT have permission to be interviewed.

As a Teen Prevention Education Program (Teen PEP) peer educator, I will be aware that I am a role model in my school and community, and I will behave accordingly. Specifically, I will uphold the rules of my school both in and out of the school building. *

I agree with the statement shown above

I disagree with the statement shown above

Please enter your class schedule with each teacher's name. Example: Period 1 Health Davis Period 2 English Philbert, etc. *

Please provide at least two references in the Central High School building (teacher, counselor, administrator etc.) who we can contact regarding you as a potential Teen PEP member. *List people who know you best and you have spoken to about this application.

Please enter your current GPA and overall GPA

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