Application

LSSU Newman Center Residential Communities Application

* Indicates required field

Name *

First

Last

Age *

LSSU Student ID Number (optional) *

Current Address at University *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone *

Cell Phone *

LSSU Email (LSSU email Preferred) *

Parent or Guardian's Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Name of Parent(s) or Guardian(s) *

Phone Number *

Date of Birth *

University Status

Year of School *

Freshman/First Year Sophomore/ Second Year Junior/ Third Year Senior/ Four year

Major *

Anticipated Graduation Date *

How long have you been at Lake State? *

I am applying for the academic year of *

Short Answers Questions

Why are you applying to become a member of this community? *

Do you have any health problems that might interfere with your ability to live in this residential community (allergies, diabetes, asthma, epilepsy, high blood pressure, and permanent injury, physical, emotional, or stress-related problems?) If so, please explain. *

Have you been seeing a counselor(s) for any problems? *

Yes No

How are you at following directions and receiving constructive criticism? Please explain: *

Home Parish Information

Parish Name *

Pastor *

Parish Address *

Line 1

Line 2

City

State

Zip Code

Country

Parish Phone Number *

What involvement have you had at your home parish? *

Resident Questions

List and describe the different work experiences you have had, beginning with the most recent. *

Do you consider yourself personally neat and clean? *

Yes No

Does this carry over into your work? *

Yes No

Please Explain: *

What do you think you can gain from living in community? *

What can you give to LSSU Catholic Newman Center as a Residential Peer Minister? *

Previous involvement academically, socially, and spiritually: in high school and/ or Newman Center *

Family Statistics

Describe your greatest strength (quality) as a person *

Describe your greatest weakness as a person? *

Job Questions

Are you willing to commit yourself to a minimum of 10-12 hours of work per week? *

Yes No

Are you willing to make yourself visible to the Campus Ministry Community and also at St. Joseph’s Parish through participation in Newman Center activities? *

Yes No

How do you see that happening? *

What organizations are you involved with now, and approximately how many hours per week are you committed? *

Is there any information that you wish to share with us? *

Which position our you applying for? *