Tools:

Yavapai College SLC Membership Application: 2012-13

If you have questions please contact Jennifer Jacobson at (928) 771- 6192 or by
email at studentleadershipcouncil@yc.edu.

Please read the Application Instructions

Deadline for applications is March 1st, 2012.
You will be notified by email if you have been selected to the SLC by June 1st, 2012.

1) Carefully complete all parts of this application. If an item does not apply to you, write “NA” in that area.
2) Resumes are NOT accepted in lieu of completed applications, but may be emailed as supplemental information.
 
3) You must mail your official transcripts from the school you attended most recently directly to Dr. Jacobson through the post office, postmarked by March 1st, 2012.
Mail to:
Dr. Jennifer Jacobson
Liberal Arts Division
Yavapai College
1100 E. Sheldon St.
Prescott, Arizona 86301
 
* required fields

Personal Information
First Name *
Last Name *
Date of Birth (DD/MM/YYYY)
 *
Y Number *
Current Address (number, street, Apt) *
City *
State *
ZIP *
Daytime Phone *
E-mail Address *
Alternate E-mail Address
Have you ever been convicted of (or plea bargained to) a felony conviction? Yes No *
If yes, please state the nature, resolution, and date of the case(s). A conviction will not necessarily disqualify an applicant from the position.

Academic Information
What is your area of study at YC? *
When do you expect to complete your studies at YC? *
What is your cumulative GPA? (at YC or your most recent school) *

Education
Do you have a high school diploma or GED? Yes No *
List schools attended beyond high school (please list most recent first).
1) School name and years completed:    1 2 3 4 *
1) Degree received: *
2) School name and years completed:    1 2 3 4
2) Degree received:

Recent Employment or Volunteer History
Most Recent Employer *
Employment dates *
Address (City, State, ZIP) *
Supervisor *
Phone Number *
May we contact this employer? Yes No *
Description of duties *
Reason for leaving *
Do you have a volunteer experience you would like to describe?

Leadership
Describe your most important experience with leadership. What role did you play? *
Describe 2 things you would like to accomplish as a member of the SLC. *
Describe a challenge you have had in your academic life and what you did to get through or overcome this challenge. *
  I certify that all answers given by me to the questions on this application are true and complete.*

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