Leaderville UWA

Name
Address
City
*State*		*Zip*
Home Phone
Other Phone
Email
City/School
School Phone
Principal
Best time/place to be reached
*Shirt Size*

Number of years of Educational Experience
In Education		In Co-Curricular Activities
Teaching		Advising
Directing Student Activities		Administrating

List co-curricular activities you have advised and number of years in each:

List student workshops/conferences/student activities you have experiences/participated in/presented at:

List major activities in which you have had a leadership role; briefly define role (prefer those win which students were involved):

List specific skills you possess which you think would be valuable in a student leadership workshop. Please define each skill briefly.

Why do you want to be a Leaderville staff member?

Statements and/or letters of recommendation (administrators, principals, activity director, etc.)

Please include a recent snapshot and email to leadervilleuwa@yahoo.com or mail to:
Leaderville UWA Office of Student Affairs UWA Station 4 Livingston, AL 35470
*DEADLINE: March 15, 2004*

Leaderville UWA would like to have all staff selected and applicants notified by April 7, 2004. If you have not heard and/or need to know if you were selected in order to resolve other summer opportunities and plans, please feel free to call the Leaderville UWA Office at (205) 652-3523 or leadervilleuwa@yahoo.com