Multicultural Community Partners Program

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Multicultural Family Literacy Program Application

Please use this form to sign up as a participant for the 2008 Multicultural Family Literacy Program.

 

First Name:
Last Name:
Student ID:
UM E-mail:
Address:
City:
State:
Zip Code:
School Address
School Phone:
Phone Number:
Cumulative GPA:
College (ie. CLA, IT, CBS):
Year in school:
Freshmen
Sophmore
Junior
Senior
Major:
Minor:
Check the program(s) you are applying for:
Citizen-Scholor Scholarship Program
Family Literacy Program
Do you have work study and/or financial aid eligibility?:If you answer No, Please consult Financial Aid at 612-624-1665 to inquire about getting work-study eligibility.
Yes
No
Do you have a car and would you be willing to car pool if you qualify?
Yes
No
Are you interested in working at an ethnic specific site?
African American
American Indian
Asian Pacific American
Chicano Latino
Other
Please List two professional references which we can contact. (no friends or family):
  Reference #1
Name:
Job Title:
Phone Number:
Relationship:
  Reference #2
Name:
Job Title:
Phone Number:
Relationship:
I certify that the information I have given in this application is accurate and up-to-date. I understand that if I have misrepresented application information and have failed to adhere to program guidelines, I may have my application withdrawn. I understand that to qualify for some sites, the agency may conduct a background check on me pursuant of the Minnesota Child Protection Background Check Act.
Signature:
Date:

 
174 Appleby Hall, 128 Pleasant Street SE, Minneapolis, MN 55455 • Tel. 612.624.6386 | Fax. 612.624.9028 | Email. mcae@umn.edu