Cortina Community Application

Cortina Community Application

2010-2011

Department of Residence Life

Department of Residence Life

CreightonCenter for Service & Justice

CreightonUniversity
2500 CaliforniaPlaza
Omaha, Nebraska

Phone: (402) 546.6919

APPLICANT INFORMATION

NET ID / Last Name / First
Name / Middle
Initial
Home Street Address / City: / State:
Zip Code / Phone (Home or where you can be reached):
Gender / Male Female / Age
Email Address /
Intended
Academic Major

CAMPUS INVOLVEMENT

ESSAY QUESTIONS

REFERENCES

Provide the names and contact information for three (3) professional references. At least two of these individuals must be from Creighton. Creighton references include only faculty members or staff, academic advisors, and Residence Life staff members. Each reference must complete the Reference Form in this application packet and submit the form independently from the applicant.

Name:
Title:
Contact Phone #:
How do you know this person?
How long have your known this person?
Name:
Title:
Contact Phone #:
How do you know this person?
How long have your known this person?
Name:
Title:
Contact Phone #:
How do you know this person?
How long have your known this person?

AGREEMENT

SUBMISSION INSTRUCTIONS

Please return your printed application with all supporting documentation (resume and essays)

by 5pm on Friday, December 4, 2009 to the McGloin Hall front desk. Upon submitting

your materials, you will sign up for an interview to be held during the week of January 18, 2010

at the CreightonCenter for Service and Justice in the HarperCenter. Please be prepared to sign up

for an interview when you submit your application.

Please direct questions to:

Emily A. Hunt

Director--Cortina Community Program

402.546.6919 or

*****Note: Your application is not complete and will not be considered until all

supporting materials are received. Please follow up with your references as needed.

FOR OFFICE USE ONLY

Application Assessment Applicant Review

Resume received: ______References (3) received: _____

Essays(3) received: _____ GPA Check: _____

Name of Receiver: ______Judicial (CSI) Check: _____

Interview Information Application Review

Date of Interview ______Application Score: ______

Time of Interview ______Name of Reviewer ______

REFERENCE FORM- NOTE: 3 REFERENCES ARE REQUIRED

Applicant Name ______

1. How well do you know this applicant?

2. Have you ever had a discussion about service or justice with the applicant? If yes, please describe.

3. In relation to commitment, please describe the applicant’s level of commitment that you have seen and describe it.

Please provide additional observations regarding the applicant (involvement, motivation, attitude, character, etc.):

Please check which statement applies to the applicant’s recommendation to the Cortina Community:

*Several reservations, should be discouraged ______

A few reservations, not sure of recommendation ______

Strong candidate ______

*Outstanding, better than most ______

*Note: If you checked either of the stared statements, please explain your choice below:

Print Name ______

Title ______

Signature ______Date ______

Please return recommendation to: Emily A. Hunt in McGloin Hall by

December 4, 2009 at 5pm. Please submit the form independently from the applicant.