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Planned Parenthood of Indiana
Education

 

Peer Educator Application

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* Required

Name: *  
Age: *  
Address 1: *  
Address 2:
City: *  
State: *  
ZIP: *  
Email address: *  
Date of birth: *  
Phone number: *  
Best time to call: *  
Parent/guardian (if under 18):
School name :
Current grade you are in this year:
Current grade point average (GPA):


In applying to the Planned Parenthood of Indiana Peer Education Program, I, the undersigned:

  1. Hereby state that all of the above statements are true;
  2. Understand that my services as a Peer Educator will be offered on a voluntary basis;
  3. Understand that it is Planned Parenthood of Indiana’s mission to Protect, Provide and Promote Reproductive Health for all and that it is Planned Parenthood of Indiana’s goal to accomplish its mission through providing reproductive health services, advocacy and education services.
 



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PPIN 2010 Annual Report



Administrative offices *
(317) 637-4343
200 South Meridian Street
Post Office Box 397
Indianapolis, Indiana  46206

* Peanut-free location.

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