Fillable Dayton Corps Application 17 (University of Dayton)

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Dayton Corps Application 17 (University of Dayton)

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File type: PDF

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Administered by:
Fitz Center for Leadership in Community
Expression of Interest
Expression of Interest is due by September 1, 201
PERSONAL INFORMATION
LAST NAME: FIRST NAME:
CURRENT STREET ADDRESS:
CITY:
STATE: ZIP CODE:
PERMANENT STREET
ADDRESS:
CITY:
STATE: ZIP CODE:
INDICATE YOUR AFFILIATION
(Check all that apply):
Community Member
Current UD Student
Other
UD ID Number (if you are a UD
student or recent alum)
EMAIL ADDRESS:
CELL PHONE NUMBER: OTHER PHONE
NUMBER:
PREFERRED METHOD OF
COMMUNICATION (check all
that apply):
Cell Phone Other number E-mail
Other
EMERGENCY CONTACT NAME
AND TELEPHONE NUMBER:
ARE YOU 18 YEARS OLD OR
OLDER?
Yes
No
ARE YOU A U.S.
CITIZEN?
Yes
No
Please indicate your t-shirt size
(Members will be provided with
AmeriCorps t-shirts to wear at
site):
Small Medium
Large Extra Large
Double Extra Large Triple Extra Large
EDUCATION
EDUCATIONAL ATTAINMENT:
Please select the highest level of
education that you have
completed
Some high school
High School Diploma or GED
Technical school/apprenticeship
Associate's degree
Some college
Bachelor's degree
Graduate degree
Other
APPLICATION INFORMATION
Which Corps positions are you
interested in at this time?
(Check all that apply)
Neighborhood Corps
Opportunity Corps
Full Time
Reduced Half Time
Quarter Time
Half Time
Full Time
Minimum Time
Minimum Time
Why do you want to participate
in AmeriCorps? What do
you hope to gain from the
experience? (750 characters
max)
What skills and talents would
you bring to the program? (750
characters max)
Education Corps
Full time
Minimum Time
Half time
Please describe the
accomplishment you are most
proud of? (750 characters max)
Is there any additional
information about yourself that
you would like to share? (750
characters max)
I certify that all of the statements and claims made in this application are true, correct, and complete to the best of
my knowledge and are made in good faith. I understand that any misinformation or misrepresentation may be cause
for disqualification or termination.
Signature: Date:
Please submit this expression of interest, along with your
resume to americorps@udayton.edu OR
Fitz Center for Leadership in Community
6W-RVHSKV+DOO
fax: 937.229.
By September 1, 201
Upon initial application review, you will receive further
instructions about next steps.
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Dayton Corps Application 17 (University of Dayton)

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Completed 22 July 2020

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