Peer Education and Engagement Program Application

Thank you for your interest in the Peer Education and Engagement Program (PEEP) at Mazzoni Center!

Mazzoni Center is looking for 30 people who are interested in becoming more versed in sexual health and wellness through sessions on topics including STIs, HIV treatment, and Trauma Informed Care. The goal of these meetings is for participants to become confident engaging in conversations with others about sexual health and wellness!

By the end of the program, all participants will have become Peer Sexual Health Ambassadors and will play an active role in developing three large community outreach events throughout 2027! Please use this form to indicate your interest, more information about the program will be sent to you after! We are looking to highlight the experiences of BIPOC Men who have sex with Men, Transgender women, and young adults (19-25), as well as those who live in North, West, and Southwest Philly, but you do not have to hold one of those identities to participate!

Please note: This program includes weekly meetings from 5:30-7:00pm beginning on Tuesday November 3rd, 2026, through February 2027, as well as working community engagement events through December 2027. Food, transportation reimbursement, financial compensation, and virtual options will be provided!

Please reach out to education@mazzonicenter.org with any questions!

Question Title

1. Please enter your contact information (Required.)

Chosen Name

Last Name

Pronouns

E-mail Address

Question Title

2. Please enter your phone number (Required.)

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3. Please enter your address (Required.)

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4. Do you live in one of the following areas? (Required.)

North Philadelphia

West Philadelphia

Southwest Philadelphia

None of the above

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5. Are you at least 18 years old?
**Must be 18 years or older to particpate (Required.)

Yes

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6. Do you identify as any of the following? Check all that apply.

**Not identifying with any of these does not automatically disqualify you. We ask this because these are our priority populations for this program.
(Required.)

BIPOC

Young Adult (19-24 years old)

MSM (men who have sex with men)

Transgender woman

None of the above

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7. Why are you interested in being a Mazzoni Center Peer Sexual Health Ambassador? (Required.)

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8. Do you have any food allergies or dietary restrictions? Please write N/A if not. (Required.)

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9. Do you have any accessibility needs? Please write N/A if not.
Ex: "I can only stand for 4 hours," "I need wheelchair accessible spaces," etc (Required.)

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10. Do you have availability Tuesday evenings from 5:30-7:00pm?

November 3rd, 10th, and 17th
December 1st, 8th, and 15th
January 5th, 12th, 19th, and 26th
February 2nd, 9th, and 16th (Required.)

Yes

Maybe

Peer Education and Engagement Program Application

Question Title

* 1. Please enter your contact information (Required.)

Question Title

* 2. Please enter your phone number (Required.)

Question Title

* 3. Please enter your address (Required.)

Question Title

* 4. Do you live in one of the following areas? (Required.)

Question Title

* 5. Are you at least 18 years old? **Must be 18 years or older to particpate (Required.)

Question Title

* 6. Do you identify as any of the following? Check all that apply.**Not identifying with any of these does not automatically disqualify you. We ask this because these are our priority populations for this program. (Required.)

Question Title

* 7. Why are you interested in being a Mazzoni Center Peer Sexual Health Ambassador? (Required.)

Question Title

* 8. Do you have any food allergies or dietary restrictions? Please write N/A if not. (Required.)

Question Title

* 9. Do you have any accessibility needs? Please write N/A if not. Ex: "I can only stand for 4 hours," "I need wheelchair accessible spaces," etc (Required.)

Question Title

* 10. Do you have availability Tuesday evenings from 5:30-7:00pm?November 3rd, 10th, and 17th December 1st, 8th, and 15th January 5th, 12th, 19th, and 26thFebruary 2nd, 9th, and 16th (Required.)

1. Please enter your contact information (Required.)

2. Please enter your phone number (Required.)

3. Please enter your address (Required.)

4. Do you live in one of the following areas? (Required.)

5. Are you at least 18 years old?
**Must be 18 years or older to particpate (Required.)

6. Do you identify as any of the following? Check all that apply.

**Not identifying with any of these does not automatically disqualify you. We ask this because these are our priority populations for this program.
(Required.)

7. Why are you interested in being a Mazzoni Center Peer Sexual Health Ambassador? (Required.)

8. Do you have any food allergies or dietary restrictions? Please write N/A if not. (Required.)

9. Do you have any accessibility needs? Please write N/A if not.
Ex: "I can only stand for 4 hours," "I need wheelchair accessible spaces," etc (Required.)

10. Do you have availability Tuesday evenings from 5:30-7:00pm?

November 3rd, 10th, and 17th
December 1st, 8th, and 15th
January 5th, 12th, 19th, and 26th
February 2nd, 9th, and 16th (Required.)