UNIVERSITY OF NEW HAVEN
COMMUNITY WORK STUDY PROGRAM
Student Application
APPLICANT INFORMATION
Name
Phone Email
Major(s) Minor(s) Year (Fr, Soph, Jr Sr)
Are you over 18 years old? YES NO
Date of Birth
(dd/mm/yyyy)
Do you have a car that you will use to get to and from your site? YES NO
About how many hours per week would you like to work? Hours
Would you be available for periodic reflection sessions regarding your
work in the community?
YES NO If no, explain
Would you be interested in participating in a course that incorporates
community service?
YES NO
Which mandatory Orientation Session would you attend? Tues. Sept. 22 @ 9AM - 10:30 AM
Tues. Sept 29, @ 11:30AM - 1PM or
Wed. Oct 7, @ 3PM 4:30PM
JOBS AND/OR ORGANIZATION YOU ARE INTERESTED IN, IN ORDER OF PREFERENCE (1= MOST; 3 = LEAST):
Organization #1:
Job Title:
Organization #2:
Job Title:
Organization #3:
Job Title:
Comments: