Fall

Spring

Both Semesters

Personal Information

Student ID:	*
First Name:	*
Last Name:	*
M.I:

	Yes	No
Have you ever applied to Financial Aid for a Work Study Award?
Have you received Financial Aid for Work Study?

How many hours each week are you available?
School or College in which you are enrolled:

Major(s):
Minor(s):
Status:	Freshman Sophomore Junior Senior Graduate Special
Current GPA:

Contact Information

Street:	*
City:	*
State:	*
Zip:	*

Email:	*
Home Phone:	- *
Times to Call:
Work Phone:	-
Times to Call:

Work Experience
(List most recent first)

Most recent position:

Postion	From	To
Agency or Firm	Supervisor
Address
Duties

 

Next most recent position:

Postion	From	To
Agency or Firm	Supervisor
Address
Duties

 

Next most recent position:

Postion	From	To
Agency or Firm	Supervisor
Address
Duties

References

Give at least three (3) references, such as professors or past employers, related to the subject(s) to be tutored or your working ability. We recommend that you have two letters of reference sent to us: Panther Academic Support Services, PASS/Bolton 180, University of Wisconsin-Milwaukee, P.O. Box 413, Milwaukee, WI 53201. If possible, one letter should be from a professor in your preferred subject area.

Reference 1:

Name	Title
Address
- Phone Number

Reference 2:

Name	Title
Address
- Phone Number

Reference 3:

Name	Title
Address
- Phone Number