Supplemental Instruction Leader Application Form

Applications for Fall 2018: Due Friday, March 23 by 11 AM or until all positions are filled.

Return the completed form to the SI Office, which is located in GFS 307. Questions?

Call Judy Haw at 213-740-5295 or email your questions to .

Personal Information

First Name: ______Last Name: ______

Email:______USC ID: ______

Major(s):______Minor(s):______

Expected Graduation Date: ______Date of Birth (Month/Day Only):______

Local Address Permanent Address

______

Street Address Street Address

______

City, State, ZIP City, State, ZIP

______

Cell Phone Home Phone

Course Preference (Please only list those courses that you are willing to SI for.)

______

1st choice 2nd choice 3rd Choice

Are you able to attend SI Training on Friday, August 17 from 10-3PM?  Yes  No (Explain)

If hired, do you intend to continue in this position in the Spring 2019 semester?  Yes  No Maybe (Explain)

Academic Awards, Scholarships and Honors

1. ______

2. ______

3. ______

4. ______

Current Extracurricular Activities

1. ______

2. ______

3. ______

4. ______

SI Experience

For each SI you attended, please list the semester, the class, the name of your SI Leader and approximately how often you attended.

1. ______

2. ______

3. ______

4. ______

5. ______

Please list any previous formal or informal experience, which you think would help you as an SI Leader.

______

______

______

Photo

Please attach a copy of a recent photo of yourself. It can even be a black and white print out of an on-line photo.

Statement of Purpose

Using a separate sheet of paper (typed), please indicate why you are interested in applying for the position of Supplemental instruction leader. Include how you are qualified for the position, what you can bring to the program, what your overall goals are, and how you think this experience will enhance both yours and the participating SI student’s academic lives at USC.

Recommendations

List 2 persons I could contact for a personal recommendation if additional input is needed. It would be preferable if one were a faculty member from the same discipline as the course(s) you are applying to be a leader. Please list their name, title and phone number or email address.

1. ______

2.______

Anticipated Fall 2018 Course Load

Course Days Time Unit Total

1. ______

2. ______

3. ______

4. ______

5. ______

First semester SI Leaders cannot register for more than 18 total units. Is this a problem for you? Yes No

USC Unit Registration

To hold this job, USC policy states that a student must maintain registration in 6 units of course work as an undergraduate student. If you drop below these numbers, you must relinquish your position. Do you foresee any potential problem with your adherence to this policy? Yes No If “yes”, please explain:

By submitting this application, you certify that the facts contained in this application are true and complete to the best of your knowledge, and understand that, if employed, falsified statements shall be grounds for dismissal.

You further authorize investigation of all statements contained herein and the references and employers listed above to give us any and all information concerning previous employment and any pertinent information they may have, personal or otherwise, and release this department from all liability for any damage that may result from utilization of such information.

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SignatureDate