CIA Work-Study Application

First Name Last Name

Student ID# Phone#

Have you been awarded work-study funds? Yes No

Please mark any shifts you would be available/interested in working in, hold down the control button if selecting multiple shifts on one day.

Sunday 12pm-3pm 3pm-6pm 6pm-9pm Monday 9am-12pm 12pm-3pm 3pm-6pm 6pm-9pm Tuesday 9am-12pm 12pm-3pm 3pm-6pm 6pm-9pm Wednesday 9am-12pm 12pm-3pm 3pm-6pm 6pm-9pm

Thursday 9am-12pm 12pm-3pm 3pm-6pm 6pm-9pm 9pm-12am Friday 9am-12pm 12pm-3pm 3pm-6pm 6pm-9pm 9pm-12am Saturday 12pm-3pm 3pm-6pm 6pm-9pm 9pm-12am

Please provide us with the name of a past supervisor you have had that can serve as a work related reference:

Reference Name Phone#