Community Advisor Application

Office of University Housing

University of Central Missouri

This application must be received at the Office of University Housing (Ellis Hall, room L23) by 5:00pm on Friday, January 15, 2010.

Section I: Demographics

Name: ______

Last First Middle

Gender: [ ] Male [ ] Female UCM ID Number: ______

Local Address: ______Phone: ( )

______E-mail: ______

______

Permanent Address: ______Phone: ( )

______

______

Major: ______Minor: ______

Do you plan to be student teaching, interning, studying abroad or unavailable in another fashion for any part of the 2010-11 academic year? Yes No If yes, please explain:

______

Have you ever been charged with a crime? Yes No

If yes, please attach a separate sheet of paper with an explanation of the incident including the date the incident happened, what crime you were charged with, the details of the incident and what the final outcome was. Being charged with a crime does NOT disqualify you from becoming a Community Advisor.

Previous Work Experience (Please list the following information about your last three jobs):

Employer

/ Job Title / Dates Employed

I certify that all the information included in this application (including the back page) is correct and true to the best of my knowledge. Furthermore, I give the Office of University Housing permission to verify it through appropriate sources.

______

Signature Date

Section II: Qualifications

1.  Group Living Experience:

_____ Lived on campus at the University of Central Missouri

How many semesters? ______What Halls? ______

_____ Lived on campus at another college or university

What college or university? ______

How long? ______

_____ Other Group living experience (please explain, attach a separate sheet if necessary)

______

______

2.  Total Credits Completed by the end of Spring 2010: ______

3.  Are you currently in good standing with the University of Central Missouri?

_____ Yes, I am in good standing

_____ No, I am currently on academic probation until ______.

_____ No, I am currently on disciplinary probation until ______.

Please be aware that your Cumulative and Fall 2009 Grade Point Average will be checked to ensure that each is 2.50 or higher.

Section III: Essay (This section should be completed and submitted with the application)

Please reply to the following questions on a separate sheet of paper and submit with your application. All answers must be typed.

1.  Why do you want to be a Community Advisor?

2.  What qualities and experiences do you possess that would make you successful as a Community Advisor?

3.  What do you think will be your primary challenges or weaknesses as a Community Advisor?

Section IV: Recommendations (Due to the Office of University Housing by 5pm on January 15, 2010)

Three (3) Recommendation Forms are included with this application. Please give them to the following individuals to fill out:

1.  Any current or former Community Advisor. If you have never lived on campus, you can use any other student leader, but a CA is preferable.

2.  A current University of Central Missouri faculty or staff member (professional or graduate assistant, no undergraduate students, including other Community Advisors).

3.  A current or former employer. If this person is not local, you may substitute a second UCM faculty or staff person.

Recommendations from sources outside of these three categories will not be considered. Do not submit more than three recommendations. You may be removed from the process if your recommendations are not completed.