APPLICATION FOR FEDERAL WORK-STUDY
Instructions: (1) Complete all items below. (2) Sign your name after reading the Certifications.
Your Name ________________________________________________________ Student ID# ____________________
Address ___________________________________________________________ Telephone _____________________
! Why are you interested in a work-study position? " What skills do you possess that would be an asset if chosen?
Do you know how to type? ___ Yes ___ No If Yes, how many words per minute do you type? _____________
How do you rate your English language proficiency? ___ Very Good ___ Good ___Fair ___ Poor
Which shift do you desire to work? (Check one.) ____ Morning ____ Afternoon ____ Evening
In which area do you wish to work? (Rank 1 to 10 in order of preference; with 1 being your first choice, 10 last.)
_____ Registrar’s _____ Financial Aid _____ Placement _____ Community Service _____ Library
____ Accounting Dept. ____ Allied Health Dept. ____ ESL Dept. ____ Programming Dept. ____ Any Position
Certifications
By signing below, I understand and agree to the following:
! I must maintain satisfactory academic progress.
" If I am employed in one of the school’s student services offices, I must maintain full confidentiality of all student data with which I
come into contact, and cannot discuss or disclose such information to any current or former student, or any individual or organization
not affiliated with the school.
# If selected for FWS employment, my FWS award will end on my last day of attendance or on June 30 of the award year, whichever
comes first.
$ I will be paid on a bi-weekly basis for work performed in a satisfactory manner.
% I will be paid FWS wages only during that period of time in which I am considered to an enrolled student. Should I withdraw or be
dismissed I will no longer be eligible for employment under the FWS award.
& My FWS wages may be garnished, with proper advance notice, only to pay any costs of attendance that I owe the school, or that will
become due and payable during the period of my FWS award.
' I will not engage in the unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance during the
period covered by my FWS award.
Student’s Signature __________________________________________________ Date __________________
For Office Use Only
Program _____________________________________________ Start Date _______________ CGPA _______
Hired? ___ Yes ___ No Position ______________________________________________________________
FWS Coordinator’s Signature ____________________________________________ Date ________________
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