Montana Campus Corps members earn valuable job skills, engage in professional networking opportunities, and earn Education Awards that can be applied to tuition or student loans. The Campus Corps positions listed on this application include living stipends and some benefits (unless designated as work study). Call Colleen Kane at 243-5128 for more information.

1.	Name*

2.	Sex*
	Male Female

3.	Current Address*
	Address Line 1   Address Line 2   Address Line 3

4.	Home Phone*

5.	Cell Phone*

6.	Permanent Address If same as Current Address, please leave blank.
	Address Line 1   Address Line 2   Address Line 3

7.	Email Address*

8.	Date of Birth*

9.	Year in School

10.	Major

11.	Will you be taking at least 6 credits each semester during the academic year?*
	-- Please Select --Yes No

12.	Expected Date of Graduation

13.	Are you a United States citizen?*
	-- Please Select --Yes No

14.	If you are not a United States citizen, are you a U.S. National or lawful permanent resident alien of the US?
	-- None --Yes No

15.	How did you hear about Campus Corps?*
	Campus Corps Representative    Current/Former Campus Corps member    Friend/Relative    Internet    Newspaper    Radio    Television Ad    Poster on Campus    Info Session on Campus    Other, please specify

16.	Position Applying For* MTCC requires all MTCC campuses and all MTCC participating organizations to comply with all applicable federal and state anti-discrimination laws, including those requiring MTCC campuses and participating organizations to provide reasonable access and work activities to participants with disabilities, as well as to persons with disabilities served by MTCC campuses and participating organizations. Select at least 1 and no more than 3.
	Service Learning Liaison (450 hours/year)    YMCA After-School Program Coordinator (450 hours/year)    Volunteer and Events Coordinator (300 hours - work study)    Alternative Breaks Coordinator (300 hours - work study)    Missoula Children's Theatre (450 hours/year)    Families First/Children's Museum (450 hours/year)    Events Coordinator with Entertainment Management (450 hours/year, work study)    Watershed Education Network (450 hours/year)    SpectrUM Discovery Area Coordinator (450 hours/year)

17.	Have you served in any other AmeriCorps program?*
	-- Please Select --Yes No

18.	If yes, which one? Until October 1st, 2009 federal regulations prohibit anyone who has enrolled in two or more terms of service with AmeriCorps from enrolling in these programs, regardless of whether the terms were completed successfully.

19.	If you have any skills, talents, or interests that might be relevant to the projects, please list them (i.e., bilingual, computer skills, public speaking, etc).