Application Form
Contact Information
First Name:
Last Name:
E-mail:
Phone Number:
Can you verify that you are a citizen of the U.S.?
Yes
No
Local Address:
City, State, Zip:
Permanent Address:
City, State, Zip:
Permanent Phone#:
Major:
Expected Graduation:
Employment Experience:
From:
Place of Employment:
To:
Phone#:
(
)
Responsibilities:
From:
Place of Employment:
To:
Phone#:
(
)
Responsibilities:
What shifts would you be available to work? (Select a minimum of 3):
Sunday Afternoon, 1:00-4:00
Sunday Evening, 5:00- 8:00
Monday, 6:00-9:15
Tuesday, 6:00-9:15
Wednesday, 6:00-9:15
Thursday, 6:00-9:15
Other Information:
How did you hear about us?
(Required)
Why should alumni support the university?
(Required)
By submitting this form, I affirm that this information is complete and accurate to the best of my knowledge.
The Maryland Fund for Excellence is an equal opportunity employer. The Maryland Fund for Excellence reserves the right to contact previous employers. The University of Maryland is an equal opportunity institution with respect to both education and employment. The university's policies are in accordance with federal and state laws and regulations on non-discrimination with regard to race, color, religion, sex, sexual orientation, national origin and handicap.
***This form is transmitted by email and is not encrypted. If you wish, you may print the completed form and mail it to:
Maryland Fund for Excellence
0102 Annapolis Hall
College Park, MD 20742-5411
Samuel Riggs IV Alumni Center, College Park, MD 20742-1541
