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Sign Up Form: UConn PEP- HK Program
This application is for the Haddam-Killingworth Youth and Family Service's 2021/2022 UCONN People Empowering People (PEP Communities) Leadership Training Program.  This is a ten week program that will run starting January 6th, 2022. The program will also include 4 additional follow up sessions to support participants as they work on community projects. The sessions will take place in person from 5:30-7:30 (location TBD) unless COVID constraints move the sessions online. Dinner and babysitting will be offered for all in person sessions.
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Email *
Name *
Address *
Cell Phone number
1. How did you hear about the UCONN PEP Program?
2. Why are you interested in being in the UCONN PEP-HK Program?
3. Please list your experiences working with individuals and families.
4. List your hobbies.
5. Describe any public speaking or teaching experiences.
6. Please describe any involvement with local or other schools or community organizations.
7. Do you need childcare for this program? If so, how many children, please provide their names and ages.
8. Do you have a special interest or area of concern to the community that you would like to focus on?
9. How would you see this program as being helpful to you?
10. Do you and/or your children have any dietary restrictions or allergies? If so, please explain.
Thank you for your interest!  Either Laurie Ruderfer or Katy Kennedy will be reaching out to you to follow up on your workshop application. Any questions call the office: 860.345.7498
A copy of your responses will be emailed to the address you provided.
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