The 2018 Peer Educator Application Form
The Peer Educators’ Academy seeks to empower young people between the ages of 16 - 24 through shaping and enhancement of communication, mentorship and leadership skills. Please fill in the application form below and for any support or question please contact us at: Reach A Hand Uganda, Tel: +256 (0) 414 697 037, Email: info@reachahand.org Web: www.reachahand.org/pea

Filling in this application does not determine if you can or cannot be part of PEA. All young people are welcome.
This application just informs us of who you are.

First Name: *
Middle Name:
Last Name: *
Age *
Date of birth: *
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Contact Details
Physical address: *
Email Address: *
Phone number (mobile): *
Social media (Facebook, Twitter or Instagram ) *
For example Facebook (John Mukasa) Twitter (@johnmukasa) Instagram (@johnmukasa)
Emergency Details
Emergency Contact Information – Next of Kin. This could be, both your parents and guardian or someone with legal authority to make health and lifestyle decisions on your behalf
First Name *
Last Name *
Physical address *
Phone number (mobile) *
Email Address *
What is your relationship with the person listed above? *
Your Education background
Which level of education are you? *
Where do you go to school? *
If yes: *
If you are still in school, are you part time or full time
Are you currently employed? *
If yes, where do you work?
Have you been part of any club or societies? *
If yes, which club or societies?
How did you find out about the Peer Educators’ Academy? *
Required
What T-shirt size do you wear? *
The Application
Carefully consider the following questions before answering. There is no right or wrong answer. We encourage you to put some thought into what you write. Be as honest as possible. The answers simply provide us with information about you.
Why do you think the Peer Educators Academy would be beneficial to you? *
What is your basic understanding of sexuality? *
What are your thoughts on discussing sexuality issues with your peers? *
In what way do you think HIV and other sexually transmitted diseases have affected the way young people view sex? *
Describe your experience as a youth leader. If not yet a youth leader, how do you think you can become one? *
What do you consider to be your main strengths and weakness? *
Do you own a business running? What type of business is it? *
If not, what business would you like to start up? *
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