Leadership and Peer Support Application Form Peer Assisting is an activity in which students help students. It is a credited program offered to grade 11 and 12 students here at Beamsville District Secondary School. As a peer Assistant you will be expected to assume responsibilities not often offered to high school students. You will develop a sense of responsibility, tolerance for, and understanding of individual differences and needs. Name: ______________________________ Home Room: ______________________________ Age: ______________________________ Present Grade: ______________________________ List activities and organizations you have been involved in over the past three years, both in and out of school (eg. clubs, athletics, part-time work, etc.). List any experiences you have in leadership positions (teaching/coaching etc.).

Briefly describe why you wish to become involved as a Peer Assistant.

Briefly list what you believe the personal qualities should be for a Peer Assistant.

What do you think you can contribute to the Peer Assistant program?

Name 2 teachers you would like to use as a reference.

How many days were you absent last semester?

Where would you like your placement? Teacher preferred: _____________________ Subject/Grade Preferred:_____________________

Applicant's Signature _______________________________