Summer Enrichment Program Application

All application materials must be received no later than Monday, January 28, 2013 at 4:00pm at the Office of Multicultural Student Affairs, Holmes Hall 103. Other required application materials include a current resume, an unofficial transcript, and 3 online recommendations.

Name: 

Year in School: 

Campus Address: 

Campus Phone: 

Home Address:   Street Address

City 

State 

Zip 

Cell Phone: 

E-mail: 

Date of Birth: 

 

Ethnicity:

African American
 

Latino/a
 

Asian-American
 

Native American
 

Multiracial

Major: 

Cumulative GPA: 

1. Please list your extra-curricular activities, interests, hobbies, offices held, & honors:

High School (First-year students only):



College:

2. Referring to your resume, what are some of the things you learned from the positions you have held?

3. How do you hope to benefit from this program? Please be specific.

4. What group or team experiences have you had in the past? Please be specific.

5. What contribution(s) can you make to the program? Please be specific.

6. What accomplishment(s) are you most proud of?

Please list your references, including their name, phone and e-mail address:

Reference
Relation 		Name Phone E-mail
Staff
Supervisor
Faculty

STATEMENT OF COMMITMENT

If selected to participate in the 2013 Summer Enrichment Program, I agree to fulfill the requirements of the program and all job expectations as explained by my work supervisor.

Agree   Disagree

Date

**When completing this application, please also send or e-mail a copy of your current resume and unofficial transcript to the Office of Multicultural Student Affairs, Holmes 103, or mcaffairs@iwu.edu. Also, sign up for an interview time slot in Holmes 103.**