Name: __________________                                                         Social Security Number: _______________

Street Address: _________________________________              City: __________________

State: ___________________     Zip: ______________                 Telephone: ( )_____________

Date of Birth: ________________

High Schools Attended: ______________________         Dates: __________________

Tribal Affiliation: _______________________________________________
 
 

College or Other Schools Attended
 
 
 
 
 

Personal or Professional Achievement

Organization                 Involvement                 Office                     Years
 
 

Employment Experience

Employer                 Nature of Work                 Location                 Years
 

References

Please List two references:

Name                     Position                             Address                     Telephone #

1.
 

2.
 
 

On another sheet of paper, please describe your Personal, Academic, and Career Goals.

Include your reasons for wanting to work with Ojibwe youth. Be specific as possible.
 

PLEASE RETURN THIS APPLICATION TO:

Education Department

Tower Hall 4101

The College of St. Scholastica

1200 Kenwood Avenue

Duluth, MN 55811

(218) 723-6014