Student Worker Request Form

Student Worker Request Form
Request Date (Today's Date)*

MonthDayYear
Date
Person making the request*

First NameLast Name
Email*
Title/Position*
Department Supervisor Name*

First NameLast Name
Supervisor email*
example@example.com
Supervisor Phone Number*
Please enter a valid phone number.
Department*
Office/Room #
Student Worker Job Title/Position*
Number of open positions*
Semester Requested*
Job Description/ Skills needed*
Hours Student Needed*
Hours needed per week (19 hours MAX)*
Prefer students majoring in
Specific Student Request, if applicable.

First NameLast Name
Signature*

Clear
Should be Empty: