Community Outreach

Project Affinity Application - Summer 2013

* Required information

Name:

Student i.d.#:

BW email address:

Phone Number:

Campus or Local Address: *

Permanent Address: *

Year at BW:

Expected Graduation Date:

BW Major(s):

BW Minor(s):

Cumulative G.P.A.:

Do you have a valid driver's license?

Are you certified to drive the BW vans?

How did you find out about Project Affinity? Please check all that apply.:

Student Director OCO Staff OCO Student Leader Faculty Member BW Staff Friend

If someone referred you please provide their name so we can thank them:

Why do you want to participate in Project Affinity? What do you hope to gain? *

Service & Leadership Experience: describe your community service experience, campus involvement including any leadership positions, work and other experiences you believe may be relevant to this experience. How will these experiences be helpful to you as a Project Affinity participant? *

If you do not have previous community service experience, please describe why you are choosing to incorporate service at this point in your life.: *

Which populations (i.e. elderly, children, survivors of abuse, etc.) and issues (i.e. homelessness, environment, HIV/AIDS, cultural, etc.) would you like to work with if selected for the program.: *

Participants will live together as a community. What do you believe the benefits and challenges will be of a community living experience? How will you contribute to the community? *

Are there any major events or responsibilities (classes, family vacations, weddings, etc.) during Project Affinity that will impact your participation in the program? Please give dates if available.: *

Please list any additional information that you think is important in defining who you are and would help us to know you better.:

Please attach your resume and reference list. Please be sure to include 2-3 references & their contact info. At least one reference must be a BW faculty/staff member or student.:

Attach references:

Serious or multiple violations of college policy may jeopardize your eligibility for participation. The OCO staff will check student conduct records through the Office of Residence Life. Students are expected to be in good academic standing as well. The OCO staff may check cumulative grade point averages. The judgment of the OCO staff on this matter will be final. Information acquired will remain confidential and will be used for official purposes only.

I hereby give my consent for the OCO staff to check my records as indicated in the above statement.:

Interview Availability: please check times you ARE available:

3/19 11-11:30 am 3/19 11:30 am-12:00 pm 3/19 12-12:30 pm 3/19 12:30-1:00 pm 3/19 3-3:30 pm 3/19 3:30-4:00 pm 3/19 4-4:30 pm 3/19 4:30-5:00 pm 3/20 5-5:30 pm 5:30-6:00 pm 6-6:30 pm 6:30-7:00 pm 7-7:30 pm 7:30-8:00 pm 8-8:30 pm 8:30-9:00 pm

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