Fall 2022 M-Power Application Form

Thank you for your interest in being an M-Power Peer Educator with the Women & Gender Equity Center! In this training, student participants will learn about topics of interpersonal violence such as sexual assault, stalking, and dating violence, as well as dynamics of unhealthy and healthy relationships and how to lead these discussions with their peers.

Training dates are September 14th, 15th, and 21st from 4:30-6:30 pm in Cape Charles (Rm 2001), Webb Center

Name Name * First Last
Email *
ODU Email *
Gender (please check all that apply) *

Gender (please check all that apply) Female Male Non-Binary/Genderqueer Transgender Prefer not to disclose Other Other
What is your classification? *
College/Department *
Commitment Requirements: 6 hours of M-Power training in the Fall 2022 (divided into 3 sessions). Complete a minimum of 2 M-Power presentations & attend at least 1 WGEC event per academic semester. *

Commitment Requirements: 6 hours of M-Power training in the Fall 2022 (divided into 3 sessions). Complete a minimum of 2 M-Power presentations & attend at least 1 WGEC event per academic semester. Yes, I am willing to commit No, I am unable to commit to all the requirements
Semester Availability: (Please check all semesters that you are willing to commit to being an M-Power Peer Educator) *

Semester Availability: (Please check all semesters that you are willing to commit to being an M-Power Peer Educator) Fall 2022 Spring 2023 Fall 2023 Spring 2024
1. What are your goals for becoming an M-Power Educator? * *

1. What are your goals for becoming an M-Power Educator? * Learning & Development Enhance social responsibility/advocacy engagement Enrich Campus Life/Community Connection Other Other
2. Describe any relevant experience you may have in working with or training at the peer level. *
3. Have you or someone close to you been affected by sexual assault or relationship violence? How have you dealt with this and how will it affect your work as a peer educator? (Optional: please disclose at your discretion) *
4. Describe your experiences facilitating group discussions and/or public speaking. *
5. Please describe your commitments for the semester including course load, student groups, voulnteering, jobs, and leadership positions. *
6. What qualities do you demonstrate that would make you an exceptional peer educator on the topics associated with interpersonal violence. *
Do you have any dietary restrictions or allergies?
Please attach resume if you have one (no need to create one if you do not)

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