Name

Class Expected Date of Graduation Age

Major

Campus Address

Campus Phone

E-mail

How did you hear about POWER?

Why do you want to be involved with this program?

Please explain any background experience you have which relates to POWER (personal, organizational, employment, volunteer work, courses, etc.)

What personal strengths do you feel you will bring to the program? Please comment on any areas you would like to develop through your involvement with POWER.

This program requires a 5 hour commitment each week. How do you plan to incorporate this time into your schedule?

Please comment on any other activities you are involved in, including employment and extracurricular.

Please check all of the topic areas that interest you.

Choose the topic that interests you the most and explain why.

Please provide names, phone numbers, and e-mail addresses of two individuals (not related to you) who can serve as references (freshmen may submit names of high school teachers/counselors/advisors).

All applications must be received by 5:00 p.m. on Friday, January 29, 2010. Review of applications will begin at that time, and qualified applicants will be asked to interview starting Monday, February 8, 2010.

Thank you for your interest in POWER!

If you experience problems with the form, print out the application and mail to:

POWER
Campus Involvement Center
355 Baker University Center
593-4025

If you want to keep a copy of our questions and your responses, print ths page before submitting.