UNIVERSITY OF ALABAMA

STUDENT APPLICATION

Date of Application _____/______/______

Applying for: Semester(s)(Circle): Fall Spring Interim Summer I Summer II
Academic Year: 200___ 200___

Name (please print)

(First) (Middle) (Last)

________________________________________________________________

SS# ____-___-_______

Local Address ________________________________________________________________

Home Phone _____________________ Cell Phone_______________________

E-Mail__________________________________________________________

Please check the semester your currently in:

Freshman____ Sophomore____ Junior____ Senior____ Graduate Level____
High School____ Non-Student____

Estimated Graduation: Date___________________

Major:_____________________ Sequence:__________________ Minor:_______________________

Applying as: (Please check all acceptable options)

Volunteer
Work-Study (pre-approved by WS)
Practicum (with permission and prerequisites)
Independent Study (same as above)

Position Applying For:

ASSOCIATE PRODUCER
PRODUCER
NEWS VIDEOGRAPHER
NEWS IDEAS INTERN
OTHER:___________________

Permanent/Parent's Address

Street/Apartment/PO Box__________________________________________________

Phone:____________________

CITIZENSHIP: Please check those applicable

USA:_________________
OTHER:_______________
Date of Birth _______/______/________

Documentation: Please check those applicable

Birth Certificate:___________________
Visa:_____________________
Social Security Card:_______________

Will you work for another UA department while at CPT?

No______
Yes______ Where:__________________________________

Have you worked for another UA department in last 12 months?

No___________
Yes___________ Where:____________ Termination Date:____________

MEDIA EXPERIENCE - Work or classroom

______________________________________________________________________

References____________________________________________________________

______________________________________________________________________

MEDIA SKILL EXPERIENCE: Circle those applicable

News Videography Producing Booking Guests

News Writing Reporting Community Contacts

AP News Center Skills Computers/Word processing

Newspaper Experience Research Editing Class Experience Only

Other comments:______________________________

OTHER WORK HISTORY - firms, dates, duties

______________________________________________________________________

REFERENCES___________________________________________________________

______________________________________________________________________

CAREER GOALS - if media/TV, what aspects

______________________________________________________________________

OBJECTIVES AT WVUA 7

______________________________________________________________________

I understand that the University of Alabama is not obligated to compensate me for volunteer services rendered.

Signature_________________________________________________ Date_____________________

AVAILABILITY SCHEDULE

NAME__________________________________________________ PHONE_______________________

SEMESTER: Please Circle FALL SPRING INTERIM SUMMER I SUMMER II YEAR:__________________

Please "X" out the times when you will NOT be available to work.

MON TUES WED THURS FRI SAT SUN

10A

11A

12N

10P

REAPPLICATION INFORMATION: Complete if using this page only

ADDRESS_______________________________________________________________ _

_______________________________________________PHONE__________________ __

Applying as: (check all acceptable) Volunteer Work-Study Practicum

Work hours per week preferred: 5-10 10-15 up to 20

Specialty preferences (Check all acceptable): Studio Field AP