Supplemental Instruction Leader Application
Section 1: Background Information
Full Name:
Birthday:
Student ID #:
Email Address:
Mailing Address: Street Apt. # City State Zip Code
Cell Phone #:
Home Phone #:
Do you already have a campus work-study position? If so, please indicate the department and number of hours you will work.
Section
2: Academic Information
Academic Major:
Secondary Major (if applicable):
GPA (last semester):
Cumulative GPA:
Number of semesters you have attended classes at NECC:
For what subject (s) would you like to lead SI sessions?
With which professor do you wish to work?
Have you ever attended an SI session before?
If so, for what course?
Section 3: References
List three references we may contact regarding this application. Include at least two
references from Northern Essex Community College. (Faculty references are preferred.)
Reference Address Relationship Phone
Section 4: Extracurricular Activities at NECC
Please list any extracurricular activities in which you are involved.
