Department of Recreation and Wellness

Wellness Connection Peer Education Registration Form 

Full Name:

Year in School: 

Mailing Address:

Day Phone:   Cell Phone:   


Do you plan to be an active peer educator after this training?

Yes No Not Sure


Are you able to commit to two presentations per semester?

Yes No Not Sure


Wellness Area(s) of Interest:

Why do you want to participate in this training?

Contact the Wellness Connection or call 419.372.WELL (9355) with questions 
regarding the submission process.