1. Last Name*
2. First Name*
3. Middle Initial

1. Local/Campus Address*
2. Apt #
3. Local City*
4. Local State* selectALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
5. Local Zip*

1. Home Address
2. Home City
3. Home State  selectALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
4. Home Zip

1. Primary Phone # * - -   
2. Cell Phone # - -   
3. E-mail Address*

1. Do you have a valid Driver’s license? *    
   Yes No
2. Are you 21 years or older? *
   Yes No

1. Major
2. Minor
3. Current GPA

1. How many credits are you taking this semester?     
2. Expected Graduation Date

1. Class Standing*
   Freshman Sophomore Junior Senior Graduate Student

Please rate your skill level on the topics below using the following rating scale.

Please list the times you are available to work.

1. Sunday
2. Thursday

1. Monday
2. Friday

1. Tuesday
2. Saturday

1. Wednesday

1. What date will you be available to start?
2. Will you be able to work during summer sessions?
   Yes No