Name: Age: Major: CWID:

Classification: Freshman Sophmore Junior Senior How many hours are you taking this semester?

Have you ever had a work-study job in campus before? Yes No

If yes, what department and duties performed?

Who was you supervisor in the work-study job?

Campus phone number: Cell phone number:

Work Experience:

Describe what experience you have had working with children and what age child?

Have you had any experience working with special needs children? Yes No

If yes, describe

Are you pediatric/child certified in first aid and CPR? Yes No

Please check times you are in class