DHS Peer Mediation & Student Engagement Club Application
The Dutchtown High School Peer Mediation & Student Engagement club's purpose is to build leadership and conflict resolution skills. Peer Mediators, Engagers will be trained using materials from the Anti-Defamation League's A World of Difference Peer Training and other mediation training guides. Peer Mediators, Engagers will help students solve simple conflicts,  initiate anti-bullying programs, and promote activities that encourage student engagement and create a welcoming and safe environment. If you are ready to lead and create a safe environment for all, please complete this application and join the Peer Mediation Team! A teacher recommendation is needed, please write a teacher's email address at the end of this form for recommendation into the program.
Student's Full Name: *
Date of Birth *
Student personal Email Address *
Grade Level *
Student Cell phone, you will be added to the Peer Mediation Remind app for communication *
T-Shirt size *
Membership Questionnaire: What is Cultural Sensitivity? *
Are you comfortable talking to different and diverse groups of people? *
How do you handle conflict? *
Dues are $20 for membership which covers the Team's T-Shirt and club activities. Can you pay the $20? *
Please write your teacher's email address for teacher recommendation below *
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