DISABLED STUDENT PROGRAMS AND SE

DISABLED STUDENT PROGRAMS AND SERVICES

Student Aide Application

(209) 954-5330 Cunningham 120

Name:			Soc. Sec. Nbr:
Address:			Home Phone:
City:	State:	ZIP:	Mess/Cell Phone:

I am currently enrolled at Delta College:

Yes

If yes, number of units this semester:

Are you currently on financial aid?

Yes

Are you currently on financial aid?

Yes

GPA:

Have you worked for Delta College in the past two year?

Yes

What department:

Immediate Supervisor:

When:

Phone Nbr:

Reasons for Leaving:

I am interested in working with students with disabilities because:

I am applying for the following positions:

DSPS I

Class Aide

Mobility Aide

P. E. Aide

DSPS II

Alternate Format

Office Aide

Computer Lab

I have the following work and/or personal experience that relates to the above position/s:

Please indicate below your free time/days:

Monday

Mornings: Afternoons:

Tuesday

Mornings: Afternoons:

Wednesday

Mornings: Afternoons:

Thursday

Mornings: Afternoons:

Friday

Mornings: Afternoons:

List the class/es you received a "B" or better in at Delta College or high school. If indicating high school, please provide transcripts.

Work experience and personal references:

Name: Title: Phone (Work or Personal):

I will view videotapes, read job descriptions and complete exam for any position I am applying for and I fully understand the duties and responsibilities involved.

Signature: Date: rev. 11/04