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Peer Buddy Student
Application
PEER
BUDDY INFORMATION FORM
Please
complete the following questions:
| Name: |
_________________ |
Phone Number: |
_________________ |
| Grade: |
_________________ |
School: |
_________________ |
| Free
Period: |
_________________ |
Lunch
Period: |
_________________ |
|
|
|
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Are
you available during lunch or after school: ________________________
Guidance
Counselor: ________________________
Please
list a teacher who can be contacted as a reference
Teacher's Name: ________________________
Class
they teach: ________________________
The
students in the Life Skills classes have varying abilities and special
needs.
Please
indicate which individual you are most interested in working with by
number 1 - 4, 1 being the most interested and 4 being the least
interested.
____ Students who
have higher skills
____ Students with
autism
____ Students with
physical disabilities
____ Students with
difficulties communicating
-
Have
you had any experience working with people with disabilities? If
yes, please describe.
-
What
are some of the reasons you are interested in working with people
with disabilities?
-
Please
list any questions, concerns or comments you may have regarding the
Peer Tutoring Course.
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