Fill - Free fillable OFFICE OF STUDENT HOUSING & RESIDENTIAL LIFE RESIDENT (College of the Siskiyous) PDF form

Revised 4/14/20 1 | Page

OFFICE OF STUDENT HOUSING & RESIDENTIAL LIFE

RESIDENT ASSISTANT

APPLICATION 2020-2021 ACADEMIC YEAR

Application Deadline: May 1st, at 6:30 pm email lodges@siskiyous.edu

Recommendations Deadline: On or Before, May 15

th

at 6:30pm Emailed by Recommender ONLY.

Electronic copies of the recommendation forms( pages 6-8) are available on the school website for download.

Please complete this form entirely, submit Application and Recommendation forms by email: lodges@siskiyous.edu.

Please fill out all portions of the application. If a question is not applicable please indicate the section with a

N/A.

Any incomplete attachments or applications will not be processed. Any applications received after the

APPLICATION DEADLINE will not be considered. DO NOT TURN IN YOUR APPLICATION TO LODGE

STAFF OR OFFICE.

I. Personal Information:

_____________________________________ _______________________________________

First Name Last Name

______________________________________ _______________________________________

Permanent Home Address City, State, Zip Code

_______________________________________ _________-___________-____________

Permanent Home Address (Line 2 if needed) Home Phone Number

________-__________-__________ ☐ YES ☐ NO

_______________________________________

Cell Phone Number Can you receive Text? Primary Email Address

__________________________________________ ____________________________

College of the Siskiyous Student Email Current Building / Room Number

(If living in lodges)

II. Academic Information:

_____________________ ☐ YES ☐ NO _____________________________________

First Semester at COS Transferred to COS If marked YES, which institution(s)

(Fall 2020, Spring 2020 etc.)

Objective at COS (Check all that apply)

___________________________________ ☐ Transfer ☐ Certificate Program ☐ A.A. Degree

Current Major/Field of Study

_________ _________ _____________________

Units Planned for Enrollment Total Units Currently Expected Graduation

Fall 2020 Semester Completed Date

____________ ____________

Last Semester GPA Cumulative GPA

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III. Questions

Please answer each of the following questions.

1. What interests you about being a Resident Assistant and what are the strengths you would

bring to the position?

2. Diversity and equality are fundamental parts of living within a community. Can you please

elaborate on what they both mean to you and why they are important? If they are not

important to you, can you explain why?

3. How would you build relationships with students as a Resident Assistant, and what would be

the nature of those relationships?

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4. Describe a time when you were a successful leader during a stressful time.

5. How will this position fit in with your lifestyle, goals and college schedule?

6. Why are you applying for the Resident Assistant Position?

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IV. References and Recommender List

1. Applicant Fill this portion in:

Please list your two (2) references. One MUST be a COS faculty or professional

staff/administration member. The second may be a person you know (advisor, supervisor,

employer, high school teacher, etc.) that is

NOT a personal friend, family member or relative.

2. Please have them fill out the recommendation form attached to the application

2.1. Name ________________________________________________________

Relationship to applicant: _____________________ COS Employee: YES ☐ NO☐

2.2. Name ________________________________________________________

Relationship to applicant: _____________________ COS Employee: YES☐ NO☐

(Back up reference in case other references are unable to assist you. TWO references are mandatory and will

be counted. If a third recommendation forms submitted, it will be discarded without being opened or read. )

3

rd

Back up Reference Name ________________________________________________________

Relationship to applicant: _____________________ COS Employee: YES☐ NO☐

V. Work Experience : Paid and Volunteer

Resumes will NOT be accepted in lieu of this form.

Employer Name &

Supervisor Name and

Contact Info

Dates of

Employment

Start Date – End

Date

Duties:

Please list duties and tasks responsible for

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VI. Extracurricular Information

Will you be involved in any clubs, sports, or jobs while you are at COS this next year? If so, please list.

________________________________________________________________________________________________________

Lodge Government Representative

If you are not granted the position of Resident Assistant, would you be interested in serving

the community in the capacity as a Lodge Government Representative (LGR)? (Please mark only

ONE)

YES, I am interested

☐

NO, I am not interested

☐

I. Signature

Application Deadline: May 1,2020 Recommendation Forms Deadline: May 15

th

at 6:30pm Emailed by Recommender ONLY.

By signing this form I,________________________, verify that all of the information provided above is correct and

factual to the best of my knowledge. I understand that if this application is not completely filled out or submitted by

the deadline mentioned above I will NOT be considered as a Resident Assistant Candidate for the Academic year of

2020-2021.

Signature: _______________________________________________ Date: ________________

STAFF FILL IN ONLY: Received Date: _______________ Complete: YES

☐

NO

☐

Staff Initial: ________

Full Name

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