Personal Information:

* Denotes Required Field

First Name:*		REQUIRED
Last Name:*		REQUIRED
Middle Initial:
Address:*		REQUIRED
City:*		REQUIRED
State:*		REQUIRED
Zip:*		REQUIRED
Primary Phone:*	Area code plus number	REQUIRED
Secondary Phone:	000.000.0000
Email Address:*		REQUIRED

Education:

HS or Equivalency 2 Yr College 4 Yr College Masters Other

Are you currently employed OR a full time student:
No Yes (Where?)

Is parking requested:

No Yes

In case of Emergency, please notify:

Name: Phone:

Times of availability:

	Mo	Tues	Wed	Th	Fri	Sat	Sun
Afternoon Morning Anytime

Placement possibilities: (check areas of interest)

Information Specialist Discovery Place Clerical/Office

Behind the Scenes(specify dept.)

After School Programs Ambassador Program Other

Other Areas of interest | Comments: (200 Char limit)

Special Skills: (200 Char limit)