*CWR*
115 South Street Middletown, NY 10940 (845)341-4190 fax (845)341-41941
Washington Center Newburgh, NY 12550 (845) 562-245 fax (845)220-4062
ww.sunyorange.edu
COLLEGE WORK-STUDY REQUEST FORM
First Name:_______________________ Last Name:_________________________________
I would like to be considered for college work-study during the (check all semesters for which
you would like to be considered for a Work-Study Job):
Summer 2015 Fall 2015 Spring 2016
Address: ___________________________________ _________________ _____ ______
Street City State Zip
Phone: (___) ___________________ E-mail:_____________________________________
Major:_______________________ Number of Credits Completed at SUNY Orange:______
Important Information:
A Free Application for Federal Aid (FAFSA) MUST be on file to be considered for Work
Study
Ineligibility for other types of aid (PELL, TAP) does not necessarily mean you will be
ineligible for Work Study Funds
Completion of this form DOES NOT GUARANTEE a work study job.
Electronic Certification Agreement. By providing your “electronic” student signature, student ID # and by selecting the “Accept" button,
you consent that all of the information reported is complete and correct.
Accept ___
Student Signature:__________________________________________________ Date:___/___/_____
WARNING: If you purposely give false or misleading information on the worksheet, you may be fined, be sentenced
to jail, or both.
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