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Student Service Scholarship Application

- Student Scholarships
  - Student Service Scholarship
  - Student Service Scholarship Application

Catholic Campus Center at Washburn University
1633 SW Jewell
Topeka, KS 66044

Student Application for Student Worker Scholarship Position
Date of application: ___________________

Contact Information

_____________ ________ Last Name First Name Middle Name Suffix

__________________________________________________________________________
Present Street Address

__________________________________________________________________________
City State Zip

___________________________________
E- mail Address Social Security Number

______________________________ ____________________________________
Primary Phone Mobile Phone
______________________________
WIN #

Are you a Washburn University Student? ____YES ____NO
If yes, part-time student______ full-time student______

What is your last semester GPA?______

Are you a registered member of the Catholic Campus Center? ____YES ____NO

Do you have phone experience ? ____YES ____NO If yes, where and when?___________

Do you have clerical experience ? ____YES ____NO If yes, where and when?___________

Do you have web experience ? ____YES ____NO If yes, where and when?___________

Availability

DAY OF WEEK Time Available to Work
Tuesday _____ _______ to _______
Wednesday_____ _______ to _______
Thursday _____ _______ to _______
Friday _____ _______ to _______

Education

School Attended	Name of School (include complete address)	Did you Graduate?	Circle last year completed	Credits/ Degree	Major/Minor
High School			9 10 11 12
Undergraduate School			1 2 3 4
Graduate School
Graduate School area(s) of concentration:

References
Give name, address and telephone number of references who are not related to you and are not previous employers. (Use additional sheet if needed.)

1.
Name Address Phone
2.
Name Address Phone
3.
Name Address Phone

Employment Experience

1. Job Title _______________ From ____(Mo./Yr.) To___________(Mo./Yr.)
(Dates of Employment)
______________________________________________________________________________
Name of Employer Address of Employer
_____________________________________________________________________________
Name of Supervisor Title of Supervisor Phone No. of Supervisor
______________________________________________________________________________
Reason for leaving ______________________________________________________________________________
Description of Duties
__________________________________________________________________________________________
Beginning Salary Ending Salary

2. Job Title _______________ From ____(Mo./Yr.) To___________(Mo./Yr.)
(Dates of Employment)
______________________________________________________________________________
Name of Employer Address of Employer
_____________________________________________________________________________
Name of Supervisor Title of Supervisor Phone No. of Supervisor
______________________________________________________________________________
Reason for leaving ______________________________________________________________________________
Description of Duties
__________________________________________________________________________________________
Beginning Salary Ending Salary