If you need additional information or have questions, please contact PEPP at 874-6261.
General
Name
(First and Last)
Major
Semester of Desired Employment: Fall
Spring
Year
2012
2013
2014
Today's Date
(enter as mm/dd/yy)
Local Address
I'm a
full-time
college/university student at:
Behrend
Gannon
Edinboro
Mercyhurst
I'm a
high school
student at: East
Collegiate Academy
Address
Mailbox #
City
State
Zip
Email Address
Phone
Home (Permanent) Address
Address
(Line 1)
Address
(Line 2)
City
State
Zip
Phone
Transportation
Do you have a car?
Yes
No
If YES, would you be willing to carpool? Yes
No
I drive/ride with:
Tutoring
Days Available:
Monday
Tuesday
Wednesday
Thursday
Class Until 2:50? Yes
No
School Preference:
Wayne Middle School - 2:45 - 4:15 p.m. - Monday, Tuesday, and Wednesday
Wilson Middle School - 3:00 - 4:30 p.m. - Monday, Tuesday, and Wednesday
Central High School - 3:30 - 5:15 p.m. - Tuesday and Thursday
Subject Preference:
If service hours are required, how many are needed?
Hours
I can:
volunteer all of my time
volunteer part of my time
I need:
a paid position
a Work Study position
Other
Photo Release:
Yes
No
How did you become aware of this program?
I understand that the PEPP Academy employs
ONLY
full-time students and it is my responsibility to inform PEPP staff if my status as a full-time student changes in any way.
Yes
No
