Student Employment Regents Service Program

Name:*

First NameLast Name

Email Address:*

example@mail.tmcc.edu

Phone Number:*

Please enter a valid phone number.Format: 000-000-0000.

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

NSHE ID (Student ID Number):*

Residency Status:*

Priority is given to Nevada residents.

Year in School:*

If "Other", Please Explain:

Major:*

Eligibility Requirements

Head of HouseholdSingle ParentAge 22 or over, and have never attended college or have had a break in enrollment of two years or moreI am the first person in my immediate family to pursue a degree or certificate beyond high schoolNo support from parents or familyUnusual family or financial circumstances

Brief Explanation:

Please briefly describe the requirements you selected above.

Placement Information

Position Title:*

Employer:*

Why are you interested in this placement?

How does this placement fit your career goals?

What knowledge, skills and abilities do you possess that qualify you for this placement?

Certification and Acknowledgment

I hereby agree to abide by the program's requirements and that all the information in this application is accurate and complete.

I hereby understand I must maintain 6 credit enrollment at TMCC in Fall and Spring Semesters, and maintain a 2.0 cumulative GPA.

Please verify that you are human:*

Sender Name: