First Name

Last Name

Date of Birth

YYYY

Phone Number

(###)

###

####

Gender Identity

Gender Pronoun

Instagram, Twitter and FACEBOOK Name

Home Address

Apt

Zip Code

School / College

Grade

Counselor's Name

Average

Interests, hobbies, talents:

Parent/ Guardian's Name

PLEASE ANSWER THE FOLLOWING QUESTIONS:

Why do you think it is important for young people to learn about sexual health information such as HIV/AIDS, STDS?

What do you think is a major health concern facing teenagers today? (Ex. Violence, HIV/AIDS, Teen Pregnancy, STDS, Etc.)

Why would you like to become a Peer or Advocate and serve your community?

How will being a Peer or Advocate help you to achieve your future goals?

WORK EXPERIENCE

Company:

Years Worked

Supervisor’s Name:

Phone:

(###)

###

####

WORK EXPERIENCE

Company:

Years Worked:

Supervisor’s Name:

Phone

(###)

###

####

Volunteer Experience:

Company

Years Worked:

Supervisor’s Name:

Phone

(###)

###

####

References:

Reference Name:

Phone

(###)

###

####

Reference Name:

Phone

(###)

###

####

Personal Statement:

Please Submit A Copy of Your Resume as A Google Doc or PDF. Grant access to view the document.

Resume

Applicants MUST be Fully Vaccinated and Boosted to work for the STAR Program at SUNY Downstate Health Sciences University.

What is your vaccination status?

Application form

SUNY Downstate Health Sciences University
450 Clarkson Avenue, MSC 1240

Brooklyn, New York 11203

1 (718) 270-3203

teenshelpingeachother@gmail.com

Application form

SUNY Downstate Health Sciences University450 Clarkson Avenue, MSC 1240

Brooklyn, New York 11203

1 (718) 270-3203

teenshelpingeachother@gmail.com

SUNY Downstate Health Sciences University
450 Clarkson Avenue, MSC 1240