HOBBIES/EXTRA-CURRICULAR ACTIVITIES
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
(beginning with most recent – if you have never worked, write N/A or NONE)
Employer: _______________________________________________
_____________________________
Address: ________________________________________________ Phone: _________________________________
________________________________________________
Dates Employed: ___________ to ___________
Summary of Duties: _____________________________________________________________________________________
_______________________________________________________________________________________________________
May we contact this employer?
Employer: _______________________________________________
Supervisor: _____________________________
Address: ________________________________________________
Phone: _________________________________
________________________________________________
___________ to ___________
Summary of Duties: _____________________________________________________________________________________
_______________________________________________________________________________________________________
May we contact this employer? Yes No
(may include WCC Staff/Faculty OR off-campus individuals who know you well)
Name: _____________________________
Relationship to You: _______________
Phone: ____________________
Name: _____________________________
Relationship to You: _______________
Phone: ____________________
CERTIFICATION AND SIGNATURE
I certify that all information reported by me in this application is TRUE and CORRECT. I understand that this information is being
provided for the receipt of federal funds and that false information may result in fines or imprisonment and will disqualify me for
employment or be grounds for subsequent dismissal. I authorize investigation of all statements contained herein. I also authorize
the employers and/or references listed to release any and all information concerning my previous employment and any pertinent
information they may have and release all parties from any liability for any damages that may result from furnishing such
information.
STUDENT SIGNATURE: _______________________________________________ DATE: ________________________
Wayne Community College is an Equal Opportunity/Affirmative Action College and accommodates the needs of individuals with disabilities. It is the
intent of the College that all programs and activities be accessible to all qualified students. It is the student’s responsibility to make his or her
disability known as soon as the need becomes known in order to provide ample time for arrangements to be made. The student must request
academic adjustments by contacting the Disability Services Counselor in the Wayne Learning Center building, 919-739-6729.
RETURN THIS COMPLETED APPLICATION TO:
Wayne Community College – Financial Aid Office – PO Box 8002 – Goldsboro,
NC 27533-8002 FAX: 919-736-9425 – EMAIL: wcc-finaid@waynecc.edu
THIS SECTION FOR FINANCIAL AID USE ONLY
18/19 FA File Complete: Yes No Unmet Need: $
Eligible for Work-Study:
Yes
No
Registered 2018FA? Yes hours No
Registered 2019SP? Yes __________ hours No
If no, reason:
SAP Status: GPA: Pace:
Remaining Eligibility: hrs.
FA Office Signature: