SI_application

Application

International Students must pass the TOEFL test before submitting this application.

Date:

mm/dd/yy

First Name:

Middle Initial:

Last Name:

PID #:

Local Address:

Include street, city, state and zip code

Local Telephone #:

Email:

Permanent Address:

Include street, city, state and zip code

Permanent Telephone #:

Student Classification:

Undergraduate

Graduate

Note: Most SI Leaders are hired as undergraduates.

Number of college credits as of last term :

College:

Major:

Accumulative GPA:

Major GPA:

Indicate the courses you prefer to serve as an SI Leader

Course 1:

Course 2:

Course 3:

Course 4:

Quarter you would like to begin:

Fall

Winter

Spring

Have you attended an SI Session?:

Yes

If so, what course(s)?:

Employment History

Do you work in another department on campus?:

Yes

If yes, which department(s)?:

List any previous or related experiences:

Include subject matter, dates, dept./employer

List any honor societies, professional memberships:

List membership and offices held, if any

Why are you interested in this position?:

Tell us what would make you a great SI Leader

What advice would you give to freshmen?:

What is your definition of academic success?:

Please provide three references below:

Name:

Address:

Include street, city, state and zip code

Relationship:

Telephone:

Email:

Reference 2

Name:

Address:

Include street, city, state and zip code

Relationship:

Telephone:

Email:

Reference 3

Name:

Address:

Include street, city, state and zip code

Relationship:

Telephone:

Email:

Please submit you information below. All online SI information will be sent to the Supplemental Instruction Coordinator via email. The Academic Advancement Center is located on the 1st floor of Alden Library.

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