Service-Learning Fellows Application

First Name:
Last Name:
Preferred Name:
Date of Birth:	(MM/DD/YYYY)
Student ID#:
Preferred Email:
Cell Phone:	(XXX-XXX-XXXX)
Address:
MSC #
Select year in school:
Major:
Ethnicity (optional):
GPA:
T-Shirt Size:
Next year will you qualify for:	Federal Work Study State Work Study NA
Have you participated in a CCASL program(s): Yes No - If yes, which program(s)
List all commitments you anticipate having next year:
Extra-curricular: write in, leader or participant, hours committed per week
Leadership: write in hours committed per week
Jobs: write in, leader or participant, hours committed per week
Other:
Please answer the following questions in no more than 250 words.
Summarize your previous volunteer/leadership experience.
Why do you want to be a leader in this program?
What qualities would you bring to this program?
How do you stay organized and set priorities?
Have you taken a Service-Learning Course? Yes No - If yes, which?
Please elaborate on all categories in which you have experience:
Public Speaking:
Event Organizing:
Leadership Experience:
Working with college students:
Working with faculty:
Working with community partners:
Data Entry:
Filing:

Reference Name:
Reference Phone:
Reference Email:
Relationship to Reference:
If selected as a leader for this program do you agree to attend:
Yes No - CCASL Retreat
Yes No - Programmatic Planning/Staff Meetings
Yes No - Reflection Activities
Yes No - Other events as assigned

If you would like to turn in a resume, please submit it to wheatley@gonzaga.edu