APPLE Upward Bound (Staff)
Staff Application
Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Cell Phone Number
*
Please enter a valid phone number.
Cell Phone Carrier
*
Text enabled?
*
Yes
No
Email
*
example@example.com
College Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student ID Number
*
Expected graduation date
*
-
Month
-
Day
Year
Date
Major, concentration, and/or minor
*
Employment Preferences
Check all that apply:
*
Not Interested
Somewhat Interested
Interested
Very Interested
Van Driver- Early
(2-5 p.m.)
Early ARG
(4-5 p.m.)
Mentoring
(5:30-7:15 p.m.)
Late ARG
(7:15-8:15 P.M.)
Van Driver- Late
(7-10 p.m.)
Employment Information
Have you ever been a TRIO program participant? If yes, when and where?
*
Have you previously worked for a TRIO program? If yes, when and where?
*
Please mark any of the following that you are certified in:
*
CPR
First Aid
Are you willing to be trained/certified as a 16-passenger van driver for driving obligations?
*
Yes
No
Have you ever worked with high school students before? If yes, in what capacity?
*
Have you ever tutored before? If yes, at what level?
*
What subjects would you feel comfortable tutoring?
*
Would you feel comfortable leading a seminar group-in an area like ACT Math, Study Skills, or College & Scholarship Research-if materials and lesson plans were provided to you?
*
Yes
No
Have you ever worked with teenagers in a mentoring capacity before? If yes, in what capacity?
*
Do you have any experience leading or facilitating group discussions? If yes, in what capacity?
*
List any present employment, including work-study, and include your supervisor as a reference below.
*
List any extracurricular activities or organizations you are involved in (e.g. academic, social).
*
List any special interests or skills.
*
Please provide contact information for three references. ALL FIELDS REQUIRED. (One must be your advisor, one must be a Lyon College faculty/staff member, and one may be someone of your choice.)
*
Name
Job Title
Email
Phone Number
Name of Company
Advisor
Faculty/Staff Reference
Additional Reference
Please upload your resume here.
*
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Please upload your unofficial transcript(s) here. If you are a transfer student, please attach transcripts for all institutions.
*
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