The Weissman Center and the CBL program look forward to learning more about your interest in working with the program, faculty, and students. Once you complete this online application, we will contact you and begin the interview process. If you have any questions, please contact the CBL office in 122 Porter Hall at x3428 or email CBL.

All fields must be completed.

Section 1: Information
Name

Email

Phone

P.O. Box

Class Year

GPA

GPA Major

Major(s)

Minor(s)

Do you receive work-study aid?

	Yes
	No

Do you have established plans to study abroad?

	Yes
	No

If so, which semester(s) will you be away?

	N/A
	Fall 2008
	Spring 2009

Please note the CBL courses that you have taken and the professors of those courses.

Are there specific community organizations with which you would like to be affiliated?
Note: The program cannot guarantee that you will be assigned to the organizations that you list here.

List all languages that you speak/write. Please note your speaking and writing proficiencies: fair, moderate, or fluent.

Please list the names of two faculty members who are willing to serve as references. Please inform the faculty members that they will be contacted by phone or e-mail about your candidacy. Please provide references who can speak to your writing and speaking skills as well as your ability to work well with other students.

Reference 1
Faculty Member:
Faculty Department:
Faculty Phone Extension:
Faculty Email:
Reference 2
Faculty Member:
Faculty Department:
Faculty Phone Extension:
Faculty Email:

Section 2: Application Statement
Please submit a 1-2 page statement in which you explain why you are interested in becoming a CBL fellow. Please describe the qualifications that you would bring to the position and highlight any related previous experience such as leadership positions, public speaking, and past mentoring opportunities. You may submit your application statement below.

Section 3: Supporting Documents
Please submit the following materials to 122 Porter Hall.
Note: Your application will not be complete until these documents are received.

1. Writing sample. Please choose a piece of writing that you have previously submitted for a college course (minimum five pages).
2. Updated resume.