New Resident Assistant Application 2013-14

University of New Haven
Office of Residential Life
Please fill in the General Information Section. Select Do you live on Campus to Yes or No, to activate the rest of the application for you to fill in.
General Information
Applicant First Name: * Last Name *
Student ID #: * Gender: *
Hall: Room #:
Cell Phone # : * Email: *
Do you live on campus: *
Academic Experience
Academic Major: * Current Class Standing: *
Last Semester GPA: * Cummulative GPA: *
Credits Completed: * Expected Year of Graduation: *
If you are a transfer student, please indicate your former institution:
Residence Hall Living Experience
How many semesters have you lived on campus?
Please list all residence halls and dates:
Student Conduct
Have you been documented for a Student Conduct/Residence Hall violation: *
Please note that one of your references should be a UNH Faculty or Staff Member. The other reference should be someone who knows you in a supervisory or advisory role.
Please list the names of the two references who will be submitting letters on your behalf in the spaces provided:
Reference #1 (UNH Affiliated Faculty or Staff Member) * Reference #2 (Knows you in a supervisory or advisory role) *
Name: Name:
Title: Title:
Phone Number: Phone Number:
Living Learning Community
Are you interested in applying for a Living Learning Community Resident Assistant position : *
Application Submission Materials
I,    * , hereby certify that all information submitted in the application and selection process in my own work, factually true, and honestly presented. Any misrepresentation of my facts may constitute a cause for non-appointment or dismissal.
I,   *  , hereby authorize and consent to the release of my records which shall include my GPA, major, confirmaiton of enrollment, and conduct status at the University fo New Haven for the purpose of verifying my qualifications for the position of Resident Assistant.
Signature of Applicant: Date: