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

Are you a transfer 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)

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

Will you have an off-campus job?  yes  no