Please fill in all parts of this application.

EMPLOYMENT STATUS:
Pleas choose whether you are applying to be a volunteer or a paid staff member (summer programs only)

Volunteer      Paid (summer programs only)

Mentor/Advisor      Academic Teacher / Tutor

Last Name     First Name    Middle Initial

Social Security #:    Date of Birth (DD/MM/YY)

Email address

Home Address

City   State   Zip  

Phone: ( )

School Address

City   State   Zip  

Phone: ( )

Father's Name       

Father's Home Address

Father's Home Phone  ( )

Mother's Name

Mother's Home Address

Mother's Home Phone   ( )

Please list an adult other than your parents who can be reached in case of emergency:

Name Relationship

Phone ( )

EDUCATION

High School     Graduation Date

Overall GPA   Awards

University Graduation Date

Overall GPA     Major/Minor (if applicable)

Academic Awards

FOREIGN LANGUAGES

Please list all foreign languages you speak, and your level of proficiency (beginning, intermediate, advanced, fluent).

Language(s) / Level of Proficiency

WORK EXPERIENCE

Please list your most significant work experience beginning with your most recent or current employment.

1. Employer

Location Hours/wk   Duration

Responsibilities

2. Employer

Location Hours/wk   Duration

Responsibilities

EXTRA-CURRICULAR ACTIVITIES

List the most significant activities and/or volunteer work you have been involved in.

1. Organization

Duration of involvement  Hours/week

Responsibilities

2. Organization

Duration of involvement  Hours/week

Responsibilities