SDS Application Page 1
|
|
- Alan King
- 8 years ago
- Views:
Transcription
1 Applications must be received by noon on Monday, June 16, 2014 The Scholarships for Disadvantaged Students (SDS) program promotes diversity among health profession students and practitioners by providing scholarships to full-time students with financial need from disadvantaged backgrounds, enrolled in health professions. All requirements including application information and supporting documentation as well as limitations to the Scholarships for Disadvantaged Students program are set forth by the Health Resources and Services Administration (HRSA) and as such are not amendable by Spalding University. To be eligible to receive funding for the Academic Year, students must be classified as graduate students in their major (MSOT, MSW, PsyD) students must be full-time for their major as defined by the University Catalog students must have submitted a FAFSA for the academic year students must demonstrate financial need as a result of a disadvantaged background students must be willing to complete program fieldwork/practicum requirements in medically underserved communities (MUC) students must be committed to post-degree career paths working with underserved populations in primary care settings. HRSA defines independent as being at least 24 years old and not having been listed as a dependent on parents income tax for 3 or more years. If a student is at least 24 years old and cannot prove independent status, then he or she would be considered dependent and the parental income will be used to determine economic disadvantage. To apply for the Scholarships for Disadvantaged Students program, ALL students must submit the following items. Please DO NOT STAPLE. Students are responsible for making copies of all documents to be submitted; the SDS Program Office will not make copies of documentation. Completed Application. Copy of drivers license, birth certificate, or passport for proof of age Copy of IRS federal 1040 tax forms for 2011, 2012, and o ONLY the form marked 1040 in the bottom right corner (1040A, 1040 EZ ) need be submitted. All addendums, worksheets, and schedules should be excluded. o If you are independent of your parents, please submit YOUR tax documents. If you are considered dependent, please submit YOUR PARENTS tax documents. o FAFSA documents may NOT be submitted in place of IRS documents. Incomplete applications will result in the application not being considered for funding. The primary indicator of disadvantaged for the Scholarships for Disadvantaged Students program at Spalding University is economic and, therefore, preference will be given to those students who meet that criterion first. Please note that racial or ethnic minority status by itself does not qualify as disadvantaged. Applications must be received by noon on Monday, June 16, 2014 Students may deliver applications to ELC 200, applications to jluther@spalding.edu, or mail applications to Judy Luther, SDS Coordinator, Spalding University, 845 S 3 rd Street, Louisville, KY Incomplete packets will not be accepted. Please DO NOT STAPLE. Students are responsible for making copies of all documents to be submitted; the SDS Program Office will not make copies of documentation. Students will be notified by mail of award or rejection of application. Once awards have been made, no appeals will be considered for further funding SDS Application Page 1
2 I am currently a full-time graduate student enrolled in the degree program selected below. I will be a full-time graduate student in the degree program selected below. Master of Science, Occupational Therapy Master of Social Work Psychology (PsyD) I submitted a Free Application for Federal Student Aid (FAFSA) for academic year Yes No (If no, applicant is not eligible.) I agree to complete program fieldwork/practicum requirements in medically underserved communities (MUC), and I am committed to working with underserved populations in primary care settings upon completing my training program. Yes No (If no, applicant is not eligible.) Student Information (please print legibly) Spalding Student ID Number: Name: Last First Middle Name or Initial Mailing Address: Number Street Apt. No. City State Zip code Telephone number: address: Gender: Female Male Birth Date (xx/xx/xxxx) Age as of 6/30/ SDS Application Page 2
3 Ethnicity One of the criteria that will be used to determine scholarship eligibility is membership in one of the traditionally under-represented groups attending higher education institutions and/or within the student s major, as defined by HRSA. Please indicate your ethnic origin/race below: Are you of Hispanic/Latino descent? Yes No Please select one or more of the following: American Indian or Alaska Native A person having origins in any of the original peoples of North/South and/or Central America and who maintains a tribal affiliation or community attachment. Asian A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, Philippine Islands Thailand, or Vietnam. Black or African American A person having origins in any of the black racial groups of Africa. Native Hawaiian or other Pacific Islander A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands. White A person having origins in any of the original peoples of Europe, the Middle East or North Africa. Individual Characteristics Please select a response for each of the following: Yes No Are you from a disadvantaged background as defined below? Comes from an environment that has inhibited the individual from obtaining the knowledge, skill, and abilities required to enroll in and graduate from a health professions school, or from a program providing education or training in an allied health profession OR Comes from a family with an annual income below a level based on low income thresholds according to family size published by the U.S. Bureau of Census, adjusted annually for changes Yes No 1 st generation college student (neither parent has completed a 4-year degree) Yes No 1 st generation graduate degree-seeking student (neither parent has completed a graduate degree Yes No Are you from a rural residential background? If yes, please indicate county, state, and zip code: Yes No Are you a veteran? If yes, please select status: Active Duty Military Reservist Prior Service Retired SDS Application Page 3
4 Financial Information/Eligibility HRSA defines independent as being at least 24 years old and not having been listed as a dependent on parents income tax for 3 or more years. If a student is at least 24 years old and cannot prove independent status, then he or she would be considered dependent and the parental income will be used to determine economic disadvantage. Please select one of the following and submit appropriate tax forms with application. DO NOT STAPLE. Include ONLY legible 1040 forms. I am 23 years of age or younger, so according to HRSA I am considered a dependent of my parents. Thus, I am submitting copies of my parents 2011, 2012, and 2013 IRS Federal 1040 tax forms (no addendums). I am 24, 25, or 26 years of age, but I have been listed as a dependent on my parents tax returns during the last 3 years. Thus, I am considered a dependent of my parents as defined by HRSA and I am submitting copies of my parents 2011, 2012, and 2013 IRS Federal 1040 tax forms (no addendums). I am at least 24 years old and considered an independent student because I have NOT been claimed as a dependent for at least 3 years. Thus, I am submitting copies of my 2011, 2012, and 2013 IRS Federal 1040 tax forms (no addendums). I am at least 24 years old and considered an independent student because I have NOT been claimed as a dependent for at least 3 years. I did not file income tax returns for one or more of 2011, 2012, 2013, so I am submitting verification from the IRS stating such. I understand that it is my responsibility to visit the IRS office in person to obtain the necessary forms stating I did not file. As reported on parents or student s 2013 Federal 1040 tax form: Number of Number of $ (AGI) Exemptions Dependents Adjusted Gross Income The table below lists the income levels that meet the 2012 economic disadvantage criterion. Please place an X next to your eligibility level to match # of exemptions. Size of Parents or Student s family * Income Level ** 1 $22,980 2 $31,020 3 $39,060 4 $47,100 5 $55,140 6 $63,180 7 $71,220 8 $79,260 * Includes only dependents listed on Federal Income tax forms. **Adjusted gross income for calendar year SDS Application Page 4
5 Summary of Eligibility Because the need of the eligible Spalding students is greater than the maximum amount of available SDS funds, each program will rank students based on Financial Information/Eligibility Amount of unmet need as the Primary Indicator. All criteria in the application will be reviewed with consideration also given to under-represented minority status, 1 st generation college student, and 1 st generation graduate degree-seeking student. Post-Degree Career Path (please select all that apply) After graduation, I intend to practice in a primary care setting. After graduation, I intend to practice in a medically underserved area. After graduation, I intend to practice in a rural setting (areas outside of cities and towns). By signing this statement, I agree to the following: To the best of my knowledge, the information I have provided in this application is true and accurate. If asked, I will provide proof of accuracy of any response I have made on this application. I understand my full application is to be reviewed by administrative and council members of the Scholarships for Disadvantaged Students in the Health Professions grant program. I understand that to be eligible I must be enrolled full-time as a graduate student in my degree program (MSOT, MSW, PsyD) as defined by the University Catalog. I must have submitted a FAFSA for academic year I agree to complete program fieldwork/practicum requirements in medically underserved communities. If I receive a scholarship, I understand I must maintain full-time enrollment as defined by the University Catalog during the academic year. To retain this scholarship, I must maintain good standing according to the policies of my degree program as defined in the University Catalog. If I receive a scholarship, I agree to respond to surveys requesting additional information to fulfill HRSA reporting requirements. If I fail to abide by all parts of this statement, I will relinquish this scholarship immediately. Signature of Applicant Date Please Print (or type) Name of Applicant SDS Application Page 5
APPLICATION FOR EMPLOYMENT INSTRUCTION SHEET
APPLICATION FOR EMPLOYMENT INSTRUCTION SHEET Thank you for your interest in Navarro College. Please take a moment to read the following instructions before completing this application. Please follow the
More informationNON-DEGREE STUDENT APPLICATION PROCESS
NON-DEGREE STUDENT APPLICATION PROCESS Thank you for your interest in taking classes as a non-degree student at St. Mary s College of Maryland. Individuals who wish to take a limited number of credit classes
More informationUNIVERSITY OF ROCHESTER SCHOOL OF NURSING. Accelerated Bachelor s Program for Non-Nurses
UNIVERSITY OF ROCHESTER SCHOOL OF NURSING Accelerated Bachelor s Program for Non-Nurses Web Page Address: www.son.rochester.edu Thank you for your interest in the University of Rochester School of Nursing.
More informationUNDERGRADUATE NON-DEGREE ENROLLMENT FORM
UNDERGRADUATE NON-DEGREE ENROLLMENT FORM UNDERGRADUATE STUDENTS ONLY: You WILL NOT be eligible for non-degree enrollment if any of the following statements apply to you. If you have: n Previously attended
More informationACHIEVE Human Services, Inc.
ACHIEVE Human Services, Inc. 3250-A East 40th Street, Yuma, AZ 85365 Phone: (928) 341-0335 Fax: (928) 341-9462 OUR MISSION STATEMENT: Empower the individuals that we serve to live their lives to their
More informationUNIVERSITY OF ROCHESTER SCHOOL OF NURSING Accelerated Masters Program for Non-Nurses
UNIVERSITY OF ROCHESTER SCHOOL OF NURSING Accelerated Masters Program for Non-Nurses Web Page Address: www.son.rochester.edu Thank you for your interest in the University of Rochester School of Nursing.
More informationUNDERGRADUATE TEACHER CERTIFICATION ENROLLMENT FORM
UNDERGRADUATE TEACHER CERTIFICATION ENROLLMENT FORM ELED, SPED and ECED are not available through the Teacher s Certification program. For any K 12 programs listed below, please seek advising from the
More informationUniversity Of Rochester School of Nursing. Leadership in Health Care Systems Masters Program Clinical Nurse Leader
University Of Rochester School of Nursing Leadership in Health Care Systems Masters Program Clinical Nurse Leader Thank you for your interest in the University of Rochester School of Nursing Clinical Nurse
More informationUNIVERSITY OF ROCHESTER SCHOOL OF NURSING Nurse Practitioner Masters Program Web Page Address: www.son.rochester.edu
UNIVERSITY OF ROCHESTER SCHOOL OF NURSING Nurse Practitioner Masters Program Web Page Address: www.son.rochester.edu Thank you for your interest in the University of Rochester School of Nursing Nurse Practitioner
More informationCollection: Hispanic or Latino OR Not Hispanic or Latino. Second, individuals are asked to indicate one or more races that apply among the following:
Overview: The United States Office of Management and Budget (OMB) issued standards for maintaining, collecting, and reporting federal data on race and ethnicity. On October 19, 2007 the Department of Education
More informationUNIVERSITY OF ROCHESTER SCHOOL OF NURSING RN to BS Program Web Page Address: www.son.rochester.edu
UNIVERSITY OF ROCHESTER SCHOOL OF NURSING RN to BS Program Web Page Address: www.son.rochester.edu Thank you for your interest in the University of Rochester School of Nursing combined RN to BS Program
More informationWATONGA ELEMENTARY SCHOOL 900 North Leach Main Office: (580) 623-5248 P.O. Box 640 Facsimile: (580) 623-5238 Watonga, Oklahoma 73772
WATONGA ELEMENTARY SCHOOL 900 North Leach Main Office: (580) 623-5248 P.O. Box 640 Facsimile: (580) 623-5238 Watonga, Oklahoma 73772 Website: www.watongapublicschools.com 2014-2015 STUDENT ENROLLMENT INFORMATION
More information2015-2016 SAMPLE APPLICATION
2015-2016 SAMPLE APPLICATION Pages in the Application 1. Eligibility 2. Student Information 3. Race and Ethnicity 4. Academic Information 5. Academic Plans 6. Activities 7. Work Experience 8. Financial
More informationApplication for Admission
Application for Admission LL.M. in International Legal Studies American University Washington College of Law INSTRUCTIONS If you have any questions please contact us at llm@wcl.american.edu before completing
More informationREQUIRED KNOWLEDGE/SKILLS:
Sysco Portland, an Operating Company of North America s Leading Foodservice Distributor, is looking for an exceptional Contract Compliance Coordinator. PURPOSE OF POSITION: This position is responsible
More informationSOUTHEASTERN TECHNICAL INSTITUTE
SOUTHEASTERN TECHNICAL INSTITUTE DENTAL ASSISTING MEDICAL ASSISTING APPLICATION FOR ACADEMIC YEAR 201 6-2017 250 Foundry Street South Easton, MA 02375 Phone: 508.238.1860 Website: www.stitech.org Southeastern
More informationDANVILLE-PITTSYLVANIA COMMUNITY SERVICES 245 HAIRSTON STREET DANVILLE, VIRGINIA 24540 434-799-0456
APPLICATION FOR EMPLOYMENT DANVILLE-PITTSYLVANIA COMMUNITY SERVICES 245 HAIRSTON STREET DANVILLE, VIRGINIA 24540 434-799-0456 INSTRUCTIONS: PLEASE READ CAREFULLY BEFORE COMPLETING THIS APPLICATION 1. The
More informationBehavior Analyst License ***************************************************************** License Requirements: APPLICATION INSTRUCTIONS
MARYLAND BOARD OF PROFESSIONAL COUNSELORS AND THERAPISTS Behavior Analyst License ***************************************************************** License Requirements: The applicant shall: (1) Have a
More informationFood Safety and Inspection Service Research Participation Program
Food Safety and Inspection Service Research Participation Program Application Date: Applicant Type: If other, please specify: Position Posting Number: 1. Name: First Name Middle Name Last Name Suffix 2.
More informationREQUIREMENTS FOR ORIGINAL OPTOMETRY LICENSURE
REQUIREMENTS FOR ORIGINAL OPTOMETRY LICENSURE Applicants must have attained their 18 th birthday. The academic requirements are at least six calendar years at the college level, four years of which shall
More informationNON-DEGREE/SPECIAL STUDENT ENROLLMENT
NON-DEGREE/SPECIAL STUDENT ENROLLMENT Enrolling as a non-degree student enables a person to take one or two graduate level social work courses per term in order to help focus their interests, to test capabilities
More informationSpeech-Language Pathologist Limited License Application Checklist
Speech-Language Pathologist Limited License Application Checklist I. All Applicants Must Submit: $100.00 Fee (check or money order payable to the Board of SLP) A recent 2x2 passport size color photo Signed
More informationHealth Care Compliance Certificate
Health Care Compliance Certificate The Health Care Compliance Certificate provides the unique skills needed to guide a health care organization through the complex maze of government laws and regulations.
More informationUNIVERSITY OF ROCHESTER SCHOOL OF NURSING
UNIVERSITY OF ROCHESTER SCHOOL OF NURSING Instructions for Applicants to the PhD Program Web page address: www.son.rochester.edu The University of Rochester School of Nursing uses a self-managed application
More informationUNIVERSITY OF ROCHESTER SCHOOL OF NURSING
UNIVERSITY OF ROCHESTER SCHOOL OF NURSING Instructions for Applicants to the DNP Program Web page address: www.son.rochester.edu Thank you for your interest in the University of Rochester School of Nursing
More informationSOUTHEASTERN TECHNICAL INSTITUTE
SOUTHEASTERN TECHNICAL INSTITUTE COSMETOLOGY CULINARY ARTS HEATING, VENTILATION AND AIR CONDITIONING APPLICATION FOR ACADEMIC YEAR 2016-2017 250 Foundry Street South Easton, MA 02375 Phone: 508.238.1860
More informationJohns Hopkins University School of Medicine. Application for Postdoctoral Research Fellowship Training
Johns Hopkins University School of Medicine Application for Postdoctoral Research Fellowship Training General Instructions for Completion of this Application Each section must be complete and legible or
More informationEMPLOYMENT APPLICATION An Equal Opportunity Affirmative Action Employer
Waukesha County Technical College 800 Main Street, Pewaukee, WI 53072 EMPLOYMENT APPLICATION An Equal Opportunity Affirmative Action Employer Position(s) Applied For Full Time Part Time Name Last First
More informationPUBLIC HEALTH - DAYTON & MONTGOMERY COUNTY APPLICATION PROCEDURES
PUBLIC HEALTH - DAYTON & MONTGOMERY COUNTY APPLICATION PROCEDURES 1. A completed Application for Employment and Consent to Procurement of Consumer Credit Report are mandatory. The Office of Human Resources
More informationEmployment Application An Equal Opportunity Employer
Employment Application An Equal Opportunity Employer PO Box 520 76 East Market Street Xenia, Ohio 45385 937-352-4000 The Greene County Public Library considers applications for all positions without regard
More informationCAMPUS ADMISSIONS APPLICATION
FORM 19-18 ASHFORD UNIVERSITY CAMPUS ADMISSIONS APPLICATION 2011/12 ACADEMIC YEAR I will be attending: Full-Time Part-Time Commuter Resident Freshman Transfer Student 1 Personal Information Start Date:
More informationNeillsville Care & Rehab
216 Sunset Pl Phone: (715) 743-5444 Fax: (715) 743-5448 An Equal Opportunity, Affirmative Action Employer Employment Application Position Applying for: PLEASE PRINT IN INK PERSONAL DATA LAST NAME FIRST
More informationHomebuyer(s) Property Address 8-30-13 REQUIREMENT DOCUMENT LENDER COMMENTS
Frederick County Department of Housing and Community Development Neighborhood Conservation Initiative (NCI) Program LENDER CHECKLIST for NCI/AG APPLICATION PACKAGE Homebuyer(s) Property Address 8-30-13
More informationEmployment Application
Office of Human Resources 3000 West Scenic Drive North Little Rock, AR 72118 Telephone (501) 812-2839 Fax (501) 812-2389 www.pulaskitech.edu Employment Application Applications for employment with Pulaski
More informationNAME: LAST NAME FIRST NAME MIDDLE INITIAL
JOHNSTON PUBLIC SCHOOLS 10 Memorial Avenue Johnston, Rhode Island 02919 Phone: 401-233-1900 / Fax: 401-233-1907 www.johnstonschools.org FULL TIME PART TIME SUBSTITUTE APPLICAT ION FO R EM PLOYM ENT C ER
More informationAPPLICATION FOR STUDENT EMPLOYMENT
LAST NAME FIRST MIDDLE INITIAL APPLICATION FOR STUDENT EMPLOYMENT N-0613 (03-13) An Equal Opportunity Employer IT IS IMPORTANT TO NOTE THAT THIS APPLICATION IS FOR STUDENT EMPLOYMENT ONLY. We realize the
More informationUniversity of Michigan STUDENT SERVICES: ADMISSIONS
RACKHAM GRADUATE SCHOOL University of Michigan STUDENT SERVICES: ADMISSIONS 915 E. Washington Street 0120 Rackham Building Ann Arbor, MI 48109-1070 E-Mail: rackadmis@umich.edu www.rackham.umich.edu/prospective-students/admissions
More information1. Name Last First Middle/Maiden. 2. Home Address. 3. Home Phone Alternate # Email. 4. Date of Birth Social Security #
State of Maryland Department of Health and Mental Hygiene Board of Examiners for Audiologists, Hearing Aid Dispensers and Speech-Language Pathologists 4201 Patterson Avenue, Baltimore, Maryland 21215-2299
More informationLicensed Clinical Professional Art Therapist LICENSURE APPLICATION INSTRUCTIONS
MARYLAND BOARD OF PROFESSIONAL COUNSELORS AND THERAPISTS Licensed Clinical Professional Art Therapist LICENSURE APPLICATION INSTRUCTIONS *The Application must be on a form currently in use by the Board.
More informationEMPLOYMENT APPLICATION
SPALDING COUNTY BOARD OF COMMISSIONERS 119 E. Solomon Street, P.O. Box 1087 Griffin, Georgia 30224 www.spaldingcounty.com EMPLOYMENT APPLICATION SPALDING COUNTY ONLY ACCEPTS APPLICATIONS FOR CURRENTLY
More informationATTORNEY APPLICATION FOR EMPLOYMENT DIVISION OF LAW DEPARTMENT OF LAW AND PUBLIC SAFETY STATE OF NEW JERSEY
ATTORNEY APPLICATION FOR EMPLOYMENT DIVISION OF LAW DEPARTMENT OF LAW AND PUBLIC SAFETY STATE OF NEW JERSEY The Division of Law provides legal counsel and representation to agencies of State government
More informationAPPLICATION FOR EMPLOYMENT
USE ONLY BLACK INK OR TYPEWRITER ON THIS FORM. INCOMPLETE APPLICATION MAY DISQUALIFY YOU FROM FURTHER CONSIDERATION. APPLICATION FOR EMPLOYMENT METROPOLITAN TRANSPORTATION AUTHORITY The MTA is an Equal
More informationGraduate Certificate Application Form and Checklist
Graduate Certificate Application Form and Checklist 6530 Haven Hall, 505 South State Street, Ann Arbor, MI 48109 Tel: (734) 615-3275 Email Application to: cogsciprog@umich.edu www.lsa.umich.edu/weinberginstitute
More informationLast Name First M.I. Date. Street Address Apartment/Unit # License Number: License Expiration Date:
Employment Application Please note: The information you enter on this form cannot be saved. After completing this form, print and provide an original signature before submitting it as application for a
More informationTRIO Student Support Services
TRIO Student Support Services Participant Application 2015-2016 Office Use Only Student Name: S# Reviewed By: First-Gen & Low-Income Disabled & Low-Income Low-Income Only First-Gen Only Disabled Denied/Not
More informationNew U.S. Department of Education Race and Ethnicity Data Standards
New U.S. Department of Education Race and Ethnicity Data Standards December 2009 Data Collection and Reporting Changes Starting School Year 2010-11 11 Data Analysis and Progress Reporting Division Illinois
More informationEMPLOYMENT APPLICATION
1161 E. Covina Blvd. Covina CA 91724 (626) 966-1632 Fax (626) 859-5249 EMPLOYMENT APPLICATION Aurora Behavioral Health Care - Charter Oak Hospital is an equal opportunity employer. Charter Oak Hospital
More informationAPPLICATION FOR EMPLOYMENT AN AFFIRMATIVE ACTION EQUAL OPPORTUNITY EMPLOYER
HUMAN RESOURCES USE ONLY DATE: TIME: APPLICATION FOR EMPLOYMENT AN AFFIRMATIVE ACTION EQUAL OPPORTUNITY EMPLOYER Instructions: Please print the requested Information In the spaces provided below. Date
More informationOhio Civil Service Application forstateandcountyagencies
Ohio Civil Service Application forstateandcountyagencies GEN-4268 (REVISED 01/12) ThestateofOhioisanEqualOpportunityEmployerandproviderofADAservices. POSITION: AGENCY: POSITION NUMBER: POSITION: DEPARTMENT:
More informationEMPLOYMENT APPLICATION
2900 E. Del Mar Blvd. Pasadena, CA 91107 (626) 356-2700 Fax (626) 356-2695 EMPLOYMENT APPLICATION Aurora Behavioral Health Care- Las Encinas Hospital is an equal opportunity employer. Las Encinas Hospital
More informationInstructions: Please complete this application, save it on your computer and attach/send it via email to hr.online@bankwithunited.com.
Application for Employment Applicants are considered for positions without regard for race, color, religion, sex, national origin, age, marital or veteran status, the presence of a physical or mental disability
More informationMinority and Women-Owned Business Enterprise (M/WBE) Participation Goals Pursuant to Article 15-A of the New York State Executive Law
Minority and Women-Owned Business Enterprise (M/WBE) Participation Goals Pursuant to Article 15-A of the New York State Executive Law The following M/WBE requirements apply when an applicant submits an
More informationAN EQUAL OPPORTUNITY EMPLOYER ~ THROUGH AFFIRMATIVE ACTION
APPLICATION FOR EMPLOYMENT ACTION FOR BRIDGEPORT COMMUNITY DEVELOPMENT 1070 PARK AVENUE, BRIDGEPORT, CT O6604 PLEASE PRINT 203 366-8241 =========================================================================================
More informationHow To Get A Good Grade At Univeristica Bmcc
1 Profiles of Accepted Dental School Applicants from one application year at UMBC The PreMedical and PreDental Advising Office, University Center 116 PreMedical PreDental PreOptometry PrePodiatry PreVeterinary
More informationInformation for Non-Degree Applicants Fall 2015 and Winter 2016 Terms only
Information for Non-Degree Applicants Fall 2015 and Winter 2016 Terms only Use this application for Non-Degree application to the following Schools and Colleges: College of Literature, Science, and the
More informationRecruiting Manager Announcement Number SE-16-0137
Career Opportunity This is not a Federal Position We are currently accepting applications to fill the following vacancy: Recruiting Manager Announcement Number SE-16-0137 OPEN DATE: March 17, 2016 CLOSING
More informationSTATE OF OREGON - OREGON YOUTH AUTHORITY EMPLOYMENT APPLICATION PERSONAL INFORMATION PREFERENCES EDUCATION COLLEGE/UNIVERSITY EDUCATION
STATE OF OREGON - OREGON YOUTH AUTHORITY EMPLOYMENT APPLICATION State of Oregon Website: http://www.oregonjobs.org For instructions on where to submit your application please see the Description section
More informationApplication for Employment
Application for Employment The Facility is an Equal Opportunity Employer. All employment decisions are made without regard to unlawful considerations of race, sex, sexual orientation, gender identity,
More informationEMPLOYMENT APPLICATION
www.pmenv.com hr@pmenv.com EMPLOYMENT APPLICATION POSITION INFORMATION POSITION DESIRED: LOCATION DESIRED: Detroit, Michigan Lansing, Michigan Grand Rapids, Michigan Decatur, Alabama Florence Alabama Charlotte
More informationCollecting and Reporting Racial and Ethnic Data Instructions and Guidance on the Federal Guidelines effective December 3, 2007
Collecting and Reporting Racial and Ethnic Data Instructions and Guidance on the Federal Guidelines effective December 3, 2007 January 2008 Maryland State Department of Education Division of Accountability
More informationCITY OF JERSEY VILLAGE, TEXAS
AN EQUAL OPPORTUNITY EMPLOYER APPLICATION FOR EMPLOYMENT CITY OF JERSEY VILLAGE, TEXAS 16501 Jersey Drive Jersey Village, Texas 77040 STATEMENT Please write legibly, or type, and use black ink. Answer
More informationCity of Tuscaloosa Affirmative Marketing Policy for Affordable Housing Programs
City of Tuscaloosa Affirmative Marketing Policy for Affordable Housing Programs Note: Affirmative Marketing procedures do not apply to families with Section 8 tenant-based rental housing assistance or
More informationEEO Employer/Vet/Disabled
Job Title: Reports to: Direct Reports: Location: Staff Accountant / Payroll Finance None San Jose, CA Education Required: High School Diploma Skills Required: The ideal candidate will have at least 3 to
More informationUniversity of South Dakota Graduate School Graduate Application for Admission
University of South Dakota Graduate School Graduate Application for Admission GRADUATE APPLICATION INSTRUCTIONS: STUDENTS FROM THE UNITED STATES Thank you for your interest in the University of South Dakota.
More informationBoones Creek Animal Hospital PLEASE COMPLETE THE FOLLOWING INFORMATION:
Boones Creek Animal Hospital PLEASE COMPLETE THE FOLLOWING INFORMATION: Job Applied For: q Receptionist q RVT q Assistant q Other HOW DID YOU LEARN ABOUT THIS POSITION? q Newspaper (List Publication) q
More informationAPPLICATION FOR APPOINTMENT TO BERKLEY/ALBANY MENTAL HEALTH COMMISSION
Thank you for your interest in improving community mental health in Berkeley and Albany. Below is some important information about the Berkeley/Albany Mental Health Commission you should review before
More informationHERCULES OFFSHORE, INC. APPLICATION FOR EMPLOYMENT. Personal Information
APPLICATION FOR EMPLOYMENT Personal Information Date: Social Security Number: - - Name: (Last) (First) (Middle) (Suffix) Address (Number and Street): County Zip City or Parish State Code Country Home Telephone
More informationP.O. Box 96027 Las Vegas NV 89193-6027 Telephone (702) 295-1600
P.O. Box 96027 Las Vegas NV 89193-6027 Telephone (702) 295-1600 Please thoroughly read the information provided below before completing the Centerra-Nevada application forms: Information on the application
More informationUNIVERSITY OF ROCHESTER SCHOOL OF NURSING. Instructions for Applicants to the MS-PhD Accelerated Programs Web page address: www.son.rochester.
UNIVERSITY OF ROCHESTER SCHOOL OF NURSING Instructions for Applicants to the MS-PhD Accelerated Programs Web page address: www.son.rochester.edu The University of Rochester School of Nursing uses a self-managed
More informationTHANK YOU FOR APPLYING AT MONROE TRUCK EQUIPMENT
1051 West 7 th Street Monroe, WI 53566 608-328-8127 ~ Fax: 608-328-4278 THANK YOU FOR APPLYING AT MONROE TRUCK EQUIPMENT We only accept applications or resumes for current job openings. When your application
More informationApplication for Employment
HH AA MM II I L T OO NN HH EE AA L T HH CC EE NN T EE RR,,, II I NN CC... 1 1 0 S 17 T H S T R E E T, H A R R I S B U R G, PA 17104 Application for Employment An Equal Opportunity Employer Hamilton Health
More informationHow To Get A Scholarship From The College Success Foundation
2015-2016 Leadership 1000 ELIGIBILITY CHECKLIST You are eligible to apply for the Leadership 1000 Scholarship if you answer yes to each of the questions below. Please note that international students,
More informationPages 1 of 8 Employment Application - Tennessee
Page 1 of 8 Employment Application Tennessee College of Applied Technology Position Applying For: Personal Information: First Name: Middle Name: Last Name: Maiden Name (If applicable): Address: City: State
More informationWashington State Association Of School Psychologists. MINORITY SCHOLARSHIP PROGRAM (2015) for Graduate Training in School Psychology
Washington State Association Of School Psychologists MINORITY SCHOLARSHIP PROGRAM (2015) for Graduate Training in School Psychology Scholarship Application www.wsasp.org Mission Statement WSASP is aware
More informationAPPLICATION FOR EMPLOYMENT City of Los Altos
APPLICATION FOR EMPLOYMENT City of Los Altos One North San Antonio Road, Los Altos, California 94022 (650) 947-2765 Fax (650) 947-2731 www.ci.los-altos.ca.us AN EQUAL OPPORTUNITY EMPLOYER FOR OFFICE USE
More informationProject Transformation Oklahoma Application PERSONAL PROFILE
PERSONAL PROFILE 1. NAME: LAST FIRST MIDDLE 2. AmeriCorps members must be a United States citizen, U.S. National or Lawful Permanent Resident. Are you a U.S. Citizen, national, or lawful permanent resident
More informationEMPLOYMENT APPLICATION
EMPLOYMENT APPLICATION The Farmers Bank 9 East Clinton St. Frankfort, IN 46041 (765)-654-8731 We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin,
More informationThank you for your interest in DePaul Fire Watch Division. We appreciate you taking the time to apply for possible employment with us.
Dear Fire Watch Applicant, Thank you for your interest in DePaul Fire Watch Division. We appreciate you taking the time to apply for possible employment with us. Throughout the application process there
More informationName Last First Middle. Address Street City State ZIP. Email. Other names you have been known by. Person who can always get a message to you
Iowa Student Loan is the parent company and sole owner of Aspire Resources Inc. 6775 Vista Drive West Des Moines, IA 50266 Phone: (800) 243-7552 Fax: (515) 273-7244 Application for Employment Name Last
More informationADMISSIONS POLICY AND PROCEDURES POLICY:
ADMISSIONS POLICY AND PROCEDURES POLICY: Section 1002.32 (4), Florida Statute - Student Admissions Each developmental research school may establish a primary research objective related to fundamental issues
More informationIPEDS R/E Data Collection & Reporting (BOF) Presented by: Barb Roy, Bryan Weeks & Craig Botkin NMSU, Boys Town April 14, 2008 Course ID 1275
IPEDS R/E Data Collection & Reporting (BOF) Presented by: Barb Roy, Bryan Weeks & Craig Botkin NMSU, Boys Town April 14, 2008 INDIVIDUAL ACHIEVEMENT. EDUCATIONAL EXCELLENCE. ADMINISTRATIVE INNOVATION.
More informationFIREFIGHTER/PARAMEDIC EMPLOYMENT APPLICATION (Please Print)
FIREFIGHTER/PARAMEDIC EMPLOYMENT APPLICATION (Please Print) FOR OFFICE USE ONLY CITY OF SPRINGFIELD, OHIO PERSONNEL DEPARTMENT 76 EAST HIGH STREET SPRINGFIELD, OHIO 45502 INSTRUCTIONS: Please fill out
More informationFirst Coast Technical College Application Procedures
First Coast Technical College Application Procedures Applications will be considered only if all paperwork is completed fully and accurately and all supporting documentation is received by the FCTC Human
More informationFrequently Asked Questions:
All completed application may be returned in person or mailed to our office at 3000 Business Center Drive Alexandria, Virginia 22314. Incomplete applications will be returned. You must include a criminal
More informationRegional Transportation District. Employment Application. Name Social Security # Name (Last) (First) ( M.I.)
Regional Transportation District Employment Application Name Social Security # Name Social Security # Name Social Security # Print all other names and social security numbers which you have used. Name
More informationweb development intern
The San Diego Association of Governments invites applications for the position of: web development intern If you are a student or recent graduate, a paid internship at SANDAG is a great way to launch your
More informationSample Employment Application
Employment Application Please complete application in full and answer all questions completely. Type or print legibly. Indicate N/A if not applicable. Do not indicate See Résumé. A résumé may be attached
More informationUniversity of Illinois College of Veterinary Medicine Coordinated Degree Program Application Package Augustana College 2015
Augustana College and University of Illinois Coordinated Degree Program Baccalaureate of Arts/Doctorate of Veterinary Medicine (BA/DVM) (version 8/28/2015) Augustana College and the College of Veterinary
More informationPatient Registration Form
Patient Registration Form MRN #: Patient Name: Provider: Sort ID: DOB: Date: Address Home Phone Cell Phone Work Social Security Number Date of Birth Male Female E-mail Address Is your visit today due to
More informationAPPLICATION FOR EMPLOYMENT
APPLICATION FOR EMPLOYMENT PRINCE WILLIAM-MANASSAS REGIONAL ADULT DETENTION CENTER 9319 Mosby Street, Manassas, Va. 20110 PHONE: 703/792-6442 OR 703/792-5840 Adult Detention Center Employment Process Information
More informationApplication for Admission
Admissions Office 800 U.S. Highway 29 N. Athens, GA 30601-1500 706-355-5004 Fax 706-369-5756 Elbert County Campus 1317 Athens Highway Elberton, GA 30635 706-213-2100 Fax 706-213-2149 Greene County Campus
More information2014-15 School District Summary
Glossary, Explanatory Text, and Links 2014-15 School District Summary AP EE FTE GED HS IEP KG LEP PK Abbreviations Advanced Placement Early Childhood Education Full Time Equivalent General Educational
More informationPHILLIPS EXETER ACADEMY
PHILLIPS EXETER ACADEMY APPLICATION FOR EMPLOYMENT The Academy is an equal opportunities employer and does not discriminate on the basis of race, color, marital status, religion, gender, age, sexual orientation,
More informationKristen DeSalvatore, Coordinator of Federal Reporting. School Year. Important: Due Date is August 7, 2015.
THE STATE EDUCATION DEPARTMENT / THE UNIVERSITY OF THE STATE OF NEW YORK / ALBANY, NY 12234 OFFICE OF P-12 (SPECIAL EDUCATION) INFORMATION AND REPORTING SERVICES (IRS) 89 WASHINGTON AVENUE RM 881 EBA ALBANY,
More informationHousing Counseling Agency Activity Report
Housing Counseling Agency Activity Report U.S. Department of Housing and Urban Development Office of Housing Counseling Federal Housing Commissioner Read the instructions and Public Reporting Statement
More information1 st Day Forms. Welcome to Senior Rehab Solutions! The following forms need to be completed prior to your first day of employ. Personnel Status Form
1 st Day Forms Welcome to Senior Rehab Solutions! The following forms need to be completed prior to your first day of employ. Personnel Status Form W-4 Form I-9 Form Request for Criminal History Check
More informationCity of Merced Housing Division Telephone: (209) 385-6863 Fax: (209) 723-1780 For Hearing Impaired please call: (209) 385-6816
City of Merced Housing Division Telephone: (209) 385-6863 Fax: (209) 723-1780 For Hearing Impaired please call: (209) 385-6816 Dear Applicant, Thank you for your interest in the City of Merced s CalHome
More informationPost-Secondary Enrollment Options Application Instructions
Post-Secondary Enrollment Options Application Instructions Please read and follow directions carefully. Incomplete applications will be returned. Step 1: Students: Complete the Applicant Information portion
More information