Name:

School ID#  

Will you be living on campus? yes    no

Permanent Address:

Will you have transportation? yes  no

Are you a commuter student?yes  no

Cell Phone:    Other Phone #:

Email:

Academic Major:

Next fall you will be: freshman  sophomore  junior  senior 

Have you worked before?  Include volunteer experience.

Position #1
Description

Duties

Dates 

Position #2
Description

Duties

Dates

Position #3
Description

Duties

Dates

Computer Skills: Mac   Word   Excel   Access   PowerPoint  

Advanced computer skills (describe briefly)

If you speak another language, what language?

Will you be involved in Athletics? yes  no
If yes, name sport(s)?

Will you have an off-campus job?  yes  no