Work Study Application Form

Please complete the application form below.

NOTE: Data entered into this form is sent as an email message.
If you see a button at the end of this sentence then your browser supports the HTML FORM element. --[ ] --

If you do not see a button between the square brackets, please email your information directly to Terry Johnson, or stop by 325 Boucke to fill out a paper application.

Please complete all of the following questions. If a question is not applicable to you, select or type "N/A" instead of leaving it blank.

Personal Information

First name:
Middle Initial:
Last name:
E-mail address:
Local Address:
Local Address 2:
Phone:	-

---

Military Service / VA Benefits:

Branch of Service:	US Army US Navy US Air Force US Marine Corps US Coast Guard National Guard Reserves
Dates of Service:
Type of Discharge:	Honorable Other Than Honorable Medical Administrative Dishonorable Bad Conduct
Do you have a Disability rated as "service-connected" by the VA? No Yes Not Certain

---

Current Penn State Status:

What is Your Major (or College/School, or DUS)?
How many credits are you taking this semester?
What is your current cumulative grade point average?
When do you plan to graduate?	Spring 2007 Summer 2007 Fall 2007 Spring 2008 Summer 2008 Fall 2008 Spring 2009 Summer 2009 Fall 2009 Spring 2010 Summer 2010 Fall 2010 Spring 2011 Summer 2011 Fall 2011 Spring 2012 Summer 2012 Fall 2012 Spring 2013 Summer 2013 Fall 2013
During which semester do you plan to enroll next?	Spring 2007 Summer 2007 Fall 2007 Spring 2008 Summer 2008 Fall 2008 Spring 2009 Summer 2009 Fall 2009 Spring 2010 Summer 2010 Fall 2010 Spring 2011 Summer 2011 Fall 2011 Spring 2012 Summer 2012 Fall 2012 Spring 2013 Summer 2013 Fall 2013
How many hours per week would you like to work?
Are you willing to work during semester breaks/spring break?	Yes No Yes, Except Summer Break
How long do you anticipate working here?	Only This Semester Every Semester Except Summer Until I Graduate
In which area are you most interested in working?	Certification/Reception Staff Veterans Outreach Peer Counseling Vocational Rehabilitation Assistant

Please give your reasons for wanting to work in this area:


What Days And Hours Would You Be Available To Work?
(example: Mon 8-10,2-3 Tue 3-5, etc..)


Briefly Describe Your Military Experience and How You View It:


Briefly Describe Any Other Full-Time Employment Experience
Or Training Which Might Be Relevant To Your Employment.


If You Have Ever Held A Part-Time Job While Attending School,
Do You Feel That You Managed Your Time Appropriately? Yes No Not Certain

How Would You Describe Your Communication Skills? Please Elaborate:


Why Have You Applied For a Work-Study Position In The Office Of Veterans Programs?


If No Positions Are Available, Would You Like Your Application To Be
Considered For Subsequent Semesters? Yes Yes, Except Summer No

Please Provide A Phone Number And The Best Time To Reach You At That Number.




By submitting this form, your information will be used only to determine your VA work study options.

None of the information entered on this form will be released to anyone or any entity outside of the Office of Veterans Programs or the VA as required.

TOP