| Springfield College

First Name

Middle Initial

Last Name

Street Address

City

State

Zip Code

Phone Number

E-mail Address

Date of Birth

Gender (optional)

What high school are you currently attending?

Are you in the 9th, 10th, 11th, or 12th grade?

In a paragraph, please introduce yourself, including why you are the best candidate for the position.

The program is designed to assist rising sophomores, juniors, and seniors in obtaining workplace skills and competencies. In 200 words or less, address how working on the Springfield College campus will give you workplace skills for launching your future workforce and/or educational pursuits.

Parent/Guardian Contact Information

Parent/Guardian Name

Parent/Guardian Phone Number

Parent/Guardian Email