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I AM APPLYING FOR THE FOLLOWING POSITION (check one):

Co-Director

Committee MemberName: ______________________________________________ Date:______________________

Panther ID # (if applicable): ____________________________ D.O.B.:____________________

E-mail Address: ______________________________________ Phone #:___________________

Major (if applicable): __________________________________ T-shirt Size: _______________

Home Address: _______________________________________________________________________

Emergency Contact (name/telephone #): __________________________________________________

Interview date/time preference: __________________________________________________________

Please answer the following questions. Use additional sheets of paper if necessary. Thank you.

1) Please explain any previous experience you have had with Global Community Engagement(GCE), Alternative Breaks (AB), coordinating/leading large-scale events, or being a member of aclub or organization.

Application Form2013 - 2014 Academic Year

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2) Please share any previous experience you have had working with philanthropies and/orcommunity agencies.

3) Why are you applying for this position?

4) Please, share three specific goals you would have for the position you are applying for.

5) Please, list all other organizations/activities you are involved with & any leadership roles youwill hold, or plan to hold, during the 2013-2014 academic year.

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Please submit a copy of your resume along with the application form (pages 4-6). Noapplications will be accepted/considered without a resume. Thank you!

Application deadline :

Thursday, September 5, 2013 by 5:00 PM . Submit application via:

o E-mail at wmaldona@fiu.edu or sarmente@fiu.edu o

Fax: (305) 348 2648 (att: Walter Maldonado)o In person: in PC 249 (att: Walter Maldonado )

Please Check:

I am interested in being a participant, keep a positive attitude, and help with fundraisingevents and the collection of supplies that will benefit the children of Santiago, DominicanRepublic.

I am interested in being a participant, volunteering during spring break in Santiago,Dominican Republic . If selected, I agree that in order to stay in the group and participate inthis service-learning trip, I must fulfill all the requirements stated in the above positiondescriptions.

If selected, I must be available to participate in this service project in the Dominican Republicfrom Friday, March 7, 2014 (morning) until Sunday, March 16, 2014 (evening) .

I hereby give permission for the Global Community Engagement and FIU chapter advisors toaccess my academic and judicial records with Florida International University and authorize myrecords to be released. I also understand that my records will be checked at the time ofapplication and prior to departure to ensure I am in good academic and judicial standings.

If you understand and agree to the above, please sign below.

_________________________________ _________________________________Signature of applicant Date

Should you have any questions, please feel free to contact Walter J. Maldonado or ShirleyCaballero, chapter advisors, at wmaldona@fiu.edu or sarmente@fiu.edu .

Official Use Only

Recommendation: Accept Accept with R eservations Do Not Accept

mailto:wmaldona@fiu.edumailto:wmaldona@fiu.edumailto:wmaldona@fiu.edumailto:sarmente@fiu.edumailto:sarmente@fiu.edumailto:sarmente@fiu.edumailto:wmaldona@fiu.edumailto:wmaldona@fiu.edumailto:wmaldona@fiu.edumailto:sarmente@fiu.edumailto:sarmente@fiu.edumailto:sarmente@fiu.edumailto:sarmente@fiu.edumailto:wmaldona@fiu.edumailto:sarmente@fiu.edumailto:wmaldona@fiu.edu