SHORE Students Helping Other Reach Excellence MEMBER FORM

Name:   Student No.:

Email:   Phone No.:

Address:

Major:   GPA:

Academic Status: (Freshman, Sophomore, etc.)

ACTIVITIES: (Please indicate the activities you are interested in)

Preparing awareness events (e.g. Alcohol Awareness Carnival) Preparing class presentations Preparing written information materials Working at awareness events Presenting to classes, groups, teams Advertising

Other:

TOPICS: (Which topics are you passionate about teaching your fellow students)

Alcohol and Drugs Sexual Assault Healthy Eating and Body Image Relationships Stress Management Self-Esteem Mental Illness Time Management Communication Study Skills Conflict Resolution Suicide Prevention Sex Diversity Dating Motivation Anger Management

Other:

SKILLS AND STRENGTHS: (Describe the skills and strengths that you have to contribute)

Return member form to CCU Counseling Services.