Application for Student Worker | College of Health Professions

Name *

First Last

In which of our programs are you a student? *

Race/Ethnicity (mark all that apply)

This is optional, but indication of race may assist in identifying candidates who may qualify for any available minority positions

Date of Birth *

Are You a Legal Resident of Arkansas? *

Are You a U.S. Citizen? *

Current Mailing Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Permanent Mailing Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Mobile Phone Number *

Email Address *

Permanent Phone (if different than Mobile)

Scholastic Honors and Significant Extracurricular Activities

Work Experience

Previous Graduate Assistantships/Student Worker Positions

What is Your Preferred Population with Which to Work? *

List Any Volunteer Activities in Which You Have Participated Related to Communication Sciences and Disorders

By checking the "I Agree" box below you are verifying that all information on this application is both complete and accurate. *

Please digitally sign this application by typing your FULL name below *

Please enter today's date *