Peer Counseling Application Form

Please answer the following questions carefully, completely, and honestly.

Return the application to Mr. Neuman (mailbox or office) no later than Friday, March 31st, 2017.

Name: Tessa Haining Advisor: Ms. Payne

Grade you entered BB&N: 7th
Free blocks and other free times (to set up an interview): A block, before school, after school Tues/Thurs

Please list two teachers and two peers that know you well (whom we could ask for a verbal recommendation of
you if needed):

Lily Brown (close fr3iend), Sarah Leder (basketball teammate and Biv squadmate), Ms. Payne (advisor), Mr.
Leith (freshman English teacher)

Please list all your extracurricular activities, both in and out of school (including athletics, clubs, leadership
positions, etc.) Also list any activities/sports you anticipate adding for next year.
- Varsity basketball
- Fall play, winter musical
- FemCo
- Library intern
- Volunteer at West End House (teaching reading/writing)
- JV crew

On a separate sheet of paper, please answer the following questions: ** Please type or write clearly **

1. What interests you about Peer Counseling? What caught your attention and led you to this?

2. What qualities or characteristics would you bring to the group?

3. What problems facing the BB&N upper school should be the primary concerns of the Peer Counseling
group? How might you go about addressing these problems?

4. How might you improve the BB&N Peer Counseling program? How could you see the Peer Counselors
becoming more visible?

5. Describe a time when you have helped someone with a problem. Please describe in as much detail as
possible.

6. Who do you turn to for support?

7. Is there anything else you would like us to know about you?

(optional bonus question) If you were a kind of footwear, what would you be?