Application for Participation in the University of Connecticut

Please complete the following information.

* 1. Address

* 2. How did you hear about the UCONN PEP Program?

* 3. Why are you interested in being in the UCONN Pep Program?

* 4. Please list your experiences working with individuals and families.

* 5. List your hobbies. 

* 6. Describe any public speaking or teaching experiences. 

* 7. Please describe any involvement with community organizations. 

* 8. Do you have any special interest that you would like us to focus on? 

* 9. How do you see this program as being helpful to you? 

* 10. Do you need child care? If so, how many children and how old? (note that child care is provided for children 2+)