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

Please complete the following information.

Address

Question Title

* 1. Address

How did you hear about the UCONN PEP Program?

Question Title

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

Why are you interested in being in the UCONN Pep Program?

Question Title

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

Please list your experiences working with individuals and families.

Question Title

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

List your hobbies. 

Question Title

* 5. List your hobbies. 

Describe any public speaking or teaching experiences. 

Question Title

* 6. Describe any public speaking or teaching experiences. 

Please describe any involvement with community organizations. 

Question Title

* 7. Please describe any involvement with community organizations. 

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

Question Title

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

How do you see this program as being helpful to you? 

Question Title

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

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

Question Title

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

T