CARL A. ELLIOTT SERVICE HONOR SOCIETY

APPLICANT INFORMATION Name: Date of Birth: CWID: Phone: Permanent Address: City: State: ZIP Code: Current Address: Apartment: City: State: Zip Code: Local Phone: E-mail: Residence Hall: EDUCATION INFORMATION Major: Minor: GPA: REFERENCES At least one reference must be an employee of The University of Alabama Name Relationship Phone

SIGNATURE

By completing this application, I give the Carl A. Elliott Service Honor Society the right to validate this information on this application. I further verify that the information that I have supplied is true and accurate to the best of my knowledge.

Signature of applicant: Date:

Response: Please type your responses and staples them to this form. If you are turning in this form by e-mail, please provide your answers in an attached word document and include your name and CWID in the top left-hand corner of response page. Thank you.

1. In list form indicate your current responsibilities in order of most important to you. Please do not include a resume.

2. Briefly describe why the top three responsibilities you listed are most important to you and what you gain from them.

3. Please list any volunteer experiences you have been involved with as a college student (include your senior year in high school if you are a freshman). From that list please briefly describe the volunteer experience that you have enjoyed the most and tell why it has been so influential to you.

*All applications must be submitted to [email protected] . No late applications will be accepted. Application deadline is February 22, 2007. Please include “YOUR NAME – Application” in the e-mail’s subject line.