| PERSONAL INFORMATION |
| Prefix: |
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| Last Name: |
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| First Name: |
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| Middle Name: |
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Campus Address:
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Local or Cell Phone with Area Code:
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| Permanent Address: |
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City:
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State:
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Zip Code:
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Home Phone with Area Code:
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| Email Address: |
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| Number of semesters you have lived in University Housing and in which Residence Halls: |
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| If hired as an SVA, are you considering additional part-time employment? |
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If yes, please describe: |
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| ACADEMIC INFORMATION |
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Primary Major : |
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Secondary Major: |
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Minor(s): |
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| Total GPA: |
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Number of Scholars Forum events attended last semester: |
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Number of Scholars Forum events attended so far this semester: |
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| SUPPLEMENTAL INFORMATION [Please respond to the following questions] |
| 1. Why are you interested in serving as a Scholars Village Assistant and what strengths will you bring to the Scholars Village? |
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| 2. Please list any leadership experience that you have that is applicable to the position. |
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| 3. What characteristics or traits distinguish you? In other words, what makes you, you? Please elaborate. |
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| 4. Can you describe a specific situation you have encountered that would help us understand how you relate to others? |
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| 5. Is there anything else you would like to share with us as we make a decision about your candidacy? |
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| If selected, you will be assigned housing in the Scholars Village as best suits your participation as an SVA. If selected as a SVA, do you have a preferred roommate you would like to bring to the Scholars Village? |
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If yes, please provide the name of your preferred roommate: |
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