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Name :   Date:


Cell Ph.:              Text Enabled?  Yes     No

College Address :     Facebook?        Yes     No


Home Address :     


Cum GPA:   A copy of your transcript and a resume are also required.

Expected graduation date:     Major:    Minor:


Have you previously worked for a TRiO program?    Yes         No

If yes, where & when? :


Please mark any of the following that you are certified in:       CPR            First Aid       Lifeguard


Are you willing to learn about and drive a 16-passenger van :         Yes     No


Have you ever worked with high school students before?:    Yes     No      


If yes, describe in what capacity:   


Have you ever tutored before?:       Yes       No       If yes, at what level?:


      What subjects would you feel comfortable tutoring?:


Have you ever worked with teenagers in a mentoring capacity before? :      Yes      No

     If yes, in what capacity?:

 Have you ever worked in a residential setting before:   Yes   No

     If yes, describe in what capacity:  

Have you ever been a TRIO program participant?:    Yes     No

     If yes, which program, where, and when?  



List any present employment, including work study, and include your supervisor as a reference below:





List any extracurricular activities or organizations you are involved in (e.g., social or academic):




List any special interests or skills you have that may enhance your work with the APPLE project. 




Please provide contact information for three references: 


         Name:   Title:     Ph:


         Name:   Title:     Ph:


         Name:    Title:      Ph:


APPLE Project is an equal opportunity employer and encourages the nomination and application of women and members of racial and ethnic minority groups.  Preference is given to applicants who have overcome barriers similar to those faced by our targeted student population.