Application for Participation in the University of Connecticut
PEOPLE EMPOWERING PEOPLE Program

Please complete the following information.

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* 1. Address

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

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

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

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* 5. List your hobbies. 

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* 6. Describe any public speaking or teaching experiences. 

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* 7. Please describe any involvement with community organizations. 

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

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

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

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