Roanoke College

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Name:
Date:
Box:
Summer Address:
Local Phone:
E-mail Address:
Class for 2012/2013 school year:

Freshman
Sophomore

Will You: Live on Campus (2012-2013)
Commute (2012-2013)
Anticipated Major:
Anticipated Minor:
Do you qualify for work study?
Approximate number of
hours per week you can work:
Are you available for
potential summer employment?
YES NO
Overall GPA:
Have you ever been found
responsible for an Academic Integrity Violation?
YES NO
Have you ever been found responsible
for a Student Conduct Violation?
YES NO
Are you or do you plan to
be an RA or in the Maroon Corps?
YES NO
Please list any computer related
courses you have taken at Roanoke College:
Have you ever held an on-campus job before? YES NO
If yes, please list what
department the job was in
and who your supervisor was.
Please list a faculty or staff member of
Roanoke College from whom we could obtain a reference.
List any experience you have with:
Software:
Telephone / Customer Service:
Equipment Experience: