Leadership Facilitator - Application

This application is for the Leadership Facilitator position for the new Leadership Learning Community at The Heights on Pecan (2013-2014).

Your Name: * First Last
Student ID #: *

1000 #
UTA Email Address: *

All communication will go through your UT Arlington student email address.
Cell Phone: * - (###) - ### ####
If no cell phone, input a contact number where you can be reached to set up an interview if selected.
Community in which you currently live: *
Semesters Living On Campus (please include Spring 2013 if you are living on campus)*: *

*Only count Fall and Spring semesters living in a residence hall or apartment complex owned by UT Arlington
Have you worked on campus at UTA? * Yes No
NET ID (Abc1234): *
Cumulative GPA as of today: *

If you do not have a GPA yet, please enter 0.00
Classification: *
Hours completed at UT Arlington: *
Expected Graduation Date: * / MM / DD YYYY
Major: *
Are you willing to move to The Heights on Pecan in order to accept this position? * Yes No
Have you ever been subject to disciplinary action as a result of conduct violation of college/university standards or regulations? * Yes No
If yes, please explain:
1. What skills and experiences will you contribute which would make you a successful Leadership Facilitator? *
2. What do you hope to gain from your experience if you are selected as a Leadership Facilitator? *
If selected as the Leadership Facilitator, would you have time during Summer 2013 to begin training? * Yes No
If no, please explain:
I certify that the statements made by me in this application are true, complete, and correct to the best of my knowledge. I understand that willfully withholding information or making false statements in this application may be considered as sufficient cause for rejection of this application, or for dismissal if such false statement is discovered after my employment. I authorize you to contact references and former employers and release The University of Texas at Arlington from any liability pertaining to investigation of my former employment and police background check.
I understand the statements above: * First Last
Date * / MM / DD YYYY
Please list below the name of two references: (1) Personal (exclude family/friends) and (1) faculty/staff

Please list their name, phone number, relationship to you, and email address. We will email a form for them to complete. It is your responsibility to make sure that they complete the form.
Name of personal reference *

Personal reference should not be a friend or family member; personal reference can be a coworker, student organization group member, mentor, etc.
Phone number of personal reference * - (###) - ### ####
Email address of personal reference *
Name of faculty/staff reference *

Faculty/staff reference can be a professor, student employee supervisor, advisor, student organization advisor, etc.
Phone number of faculty/staff reference * - (###) - ### ####
Email address of faculty/staff reference *

Leadership Facilitator - Application

Leadership Facilitator - Application

Please list below the name of two references: (1) Personal (exclude family/friends) and (1) faculty/staff Please list their name, phone number, relationship to you, and email address. We will email a form for them to complete. It is your responsibility to make sure that they complete the form.

Please list below the name of two references: (1) Personal (exclude family/friends) and (1) faculty/staff

Please list their name, phone number, relationship to you, and email address. We will email a form for them to complete. It is your responsibility to make sure that they complete the form.