STUDENT HEALTH ADVISORY BOARD(SHAB) STUDENT HEALTH SERVICE MEMBERSHIP APPLICATION FORM
NAME:
DATE: (MM/DD/YYYY)
COLLEGE OR SCHOOL (EXAMPLE: Arts & Science , Engineering, Business & Economics,etc)
MAJOR:
YEAR IN SCHOOL: FR SOPH JR SR GRADUATE
ADDRESS:
PHONE:
EMAIL ADDRESS:
NUMBER OF CREDIT HOURS TAKING THIS SEMESTER:
1. CHECK THE SHAB PROGRAMS THAT INTEREST YOU(CHECK ALL THAT APPLY)
Representing WVU at health-related seminars/conferences CPR certification Staffing information tables Health fairs Speaking at New Student Orientation about health related events Research/Surveys Others
2. WHY WOULD YOU LIKE TO JOIN SHAB?
3. WHAT ARE YOUR EDUCATIONAL/CAREER GOALS?
4. LIST STRENGTHS, ATTRIBUTES, QUALITIES THAT YOU WOULD CONTRIBUTE TO SHAB:
5. DO YOU HAVE ANY TEACHING EXPERIENCE? IF SO, PLEASE EXPLAIN BRIEFLY.
6. EXTRACURRICULAR ACTIVITIES/HOBBIES:
