First Name:
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Middle Initial:
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Last Name:
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Bronco ID Number:
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Address, City, State, Zip:
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Home Phone:
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Cell/Other Phone:
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Date of Birth:
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E-mail Address:
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Emergency Contact:
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Emergency Contact Phone:
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Emergency Contact Relationship:
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Current Year in School:
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1
2
3
4
5
Expected Graduation Quarter & Year:
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CPP College:
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Agriculture
Business
Letters, Ats, and Social Sciences
Education & Integrated Studies
Engineering
Environmental Design
Science
Collins College of Hospitality Management
Undeclared
Major:
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Minor:
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CPP GPA (min 2.2 required):
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Did you attend Orientation your first year?:
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Yes
No
Entered CPP as a:
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Freshman
Transfer
Please list high school graduated from with enrollment dates (from/to) and semesters/quarters completed.:
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Please list college/university attended other than CPP with enrollment dates (from/to) and semesters/quarters completed.:
Please list other college/university attended other than CPP with enrollment dates (from/to) and semesters/quarters completed.:
Campus Involvement - Please check all that apply:
List above involvement details:
Leadership Experience 1- Please list positions held (clubs, activities, sports, community service) If you are a Freshman, you may include high school involvement:
Leadership Experience 2 - Title/Position and dates:
Leadership Experience 3 - Title/Position and dates:
Leadership Experience 4 - Title/Position and dates:
Leadership Experience 5 - Title/Position and dates:
Employment History 1- List your present or most recent employment with title/position and dates. Add additional history below.:
Employment History 2 - Title/Position and Dates:
Employment History 3 - Title/Position and dates:
Employment History 4 - Title/Position and dates:
Employment History 5 - Title/Position and dates:
Special Skills Training - May include leadership training, CPR certification, etc:
Languages you flently SPEAK:
Languages you fluently READ:
Languages you fluently WRITE:
Reference 1 - Please list name, relationship, phone, and e-mail:
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Reference 2 - Please list name, relationship, phone, and e-mail:
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Summer obligations - List all obligations you have June-August (family commitments, tet prep courses):
Please identify what you consider to be your most significant accomplishment at CPP. (Max 1000 characters):
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Please describe why you want to be an Orientation Leader. (Max 1000 characters):
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How did you hear about this position? Please check all that apply.:
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Please list "other" from above.:
I certify that all statements on this application are true and complete to the best of my knowledge and belief. If employed, I understand that any falsification of this record may be considered cause for separation.:
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By checking the "Yes" box I hereby grant permission for Orientation Services to access my grade point average, enrollment status, and judicial/conduct records to verify any information I have provided on this application.:
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