Fillable Yess Application Fa2016 (University of Dayton)

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Yess Application Fa2016 (University of Dayton)

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Administered by:
Fitz Center for Leadership in Community
Expression of Interest
Expression of Interest is due by September 12, 2016
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):
Daybreak UD Current Student
UD Alum
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
For which member position are
you applying? (Check all that
apply)
May - August 2016 450 hours (40 hours/week)
May - August 2016 300 hours (20 hours/week)
September 2016 - May 2017 300 hours (12 hours/week)
September 2016 - December 2016 450 hours (40/week)
In which agency are you
interested in working? (Check all
that apply)
Daybreak Youth Shelter (Daybreak clients must choose Daybreak)
Homefull
St. Vincent de Paul Gateway Shelter for Men
St. Vincent de Paul Gateway Shelter for Women and Families
UD undergrads, are you able to
use this experience for
internship or independent study
credit?
Yes
No
Not sure
UD undergrads, are you
enrolled or planning to enroll
in Psych 493 (Dr. Reeb's
Independent Study Course?)
Yes
No
Not sure
Are you available to attend
weekly member training
sessions on Friday afternoons.
3:30 - 5p.m. during your term of
service?
Yes
No
Please indicate
what times you
are general
available for an
on campus
interview?
Why do you want to participate
in YESS 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)
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 yessamericorps@udayton.edu OR
Fitz Center for Leadership in Community
206 Zehler Hall
fax: 937.229.4638
By September 12, 2016
Upon initial application review, you will receive further
instructions about next steps.
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Completed 22 July 2020

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