SHAPE Program Application

Name*
First Last
Preferred Pronouns
Date of Birth*
Date Format: MM slash DD slash YYYY
Current Age*
Cell Phone Number*
Email*
Current GPA*
Grade NEXT school year*
- 9th
- 10th
- 11th
- 12th
Parent / Guardian contact information
Parent/Guardian 1 Name*
First Last
Relationship to student*
Phone*
Email*
Program Questions
Please answer each question as thoroughly as you can.
Extracurricular activities (within or outside of school):*
Please provide any volunteer experiences that may relate to this program:*
Why would you be an asset to this peer education program?*
Why is sexual health education important?*
If chosen for the program, will you have transportation to various schools in OKC and Del City on days you are scheduled to teach?*
- Yes
- No
On a scale from 1-10 (1 least and 10 most) how would you rate your desire to be a member of SHAPE?
Do you have any questions or anything else you'd like to add?
Statement of Understanding:*
If selected following an interview, I understand that parental permission is required for my involvement. I will attend a multi-day training retreat (day & night) in June (free). I understand I MUST attend a 4-day (free) training camp in October. I acknowledge that I will be taken out of school on days I am scheduled to teach (up to 5 days). I agree to strive to teach without judgment. I will do my very best to fulfill my commitments to the program. PLEASE TYPE YOUR NAME BELOW TO SERVE AS YOUR SIGNATURE.

Please call or write Kathy Harms with any questions 405-503-7081 / kathyh@teenempower.org

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After submitting the application someone will call you to tell you whether or not you may be interviewed. Please call 405-503-7081 if you have questions.

SHAPE Program Application

Parent / Guardian contact information

Program Questions