Resident Assistant Application Form
(This form can be completed in Microsoft Word)
The ability to follow directions is very important. Failure to read carefully, follow directions and
provide complete information will adversely affect your candidacy. Please type your application
responses.
Application Date:
1. Name (last, first):
2. Sex:
Male
Female
3. Student Banner Number (if known):
4. Class Standing for (16/17):
Sophomore
5. Major:
6. Minor/Concentration:
7. Last Semester GPA if applicable):
Junior
Senior
8. Cumulative GPA:
9. Campus Address (Room & Building):
10. Preferred Contact Phone #:
11. Preferred E-mail Address:
12. Home Phone (Summer):
13. Home Address (Summer):
14. Please list any extracurricular activities or commitments you anticipate for next year
(including internships, student teaching, club involvement).
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Candidates are selected to be RAs and placed where Residence Life staff feel the candidates can
best benefit the residential program and develop as staff members. Asking for preferences does
not guarantee or imply that candidates will be assigned to a specific area.
15. Which residential population would you most like to serve as an RA?
First-year students
Upperclassmen
16. Deciding whether or not to accept a specific RA assignment is a personal decision.
Candidates are encouraged to enter the application process with an open mind and
willingness to face new challenges. If you are unwilling to face the challenges of a particular
area and therefore would not accept that assignment, please indicate the area(s) now.
I am open to the challenges of any area (both Regent Commons & Regent Village).
I would not accept an assignment in/with (please indicate):
17. Have you ever been found responsible for a violation of University Policy?
No.
Yes. If yes, please indicate date(s), violation(s) and sanction(s) imposed:
18. Have you ever been convicted for any violation(s) of law (excluding traffic/parking tickets)?
No.
Yes. If yes, please indicate date(s), violation(s) and sanction(s) imposed:
19. Below please list the name, title, phone number and email address of one professional
reference. Your current RA will be used as a secondary reference.
Name:
Title:
Phone:
Email:
CERTIFICATION
I hereby certify that the information I am submitting on this RA Application Form and supporting materials is true
and complete. I understand that false or incomplete information will nullify my application and be grounds for
termination of employment if I am selected to become a Resident Assistant.
I understand that all information in this application is subject to verification. I give permission for my academic and
judicial transcript to be checked for the purpose of verifying my eligibility to be a Resident Assistant.
Applicant Signature (Electronic)
Date
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2016-2017 NEW Resident Assistant
Personal Statement
Please respond to the questions below using no more total writing space than this page (page
#3 in this packet). The personal statement must be typed (single spaced, size 12 font – Times
New Roman). Do not attach additional pages for the personal statement.
How would you describe yourself as a person? What quality do you like best in yourself and
what do you like least? What quality would you most like to see grow and which would you like
to overcome?
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2016-2017 NEW Resident Assistant
Application Short Answer Questions
Please respond to each of the short answer questions below using no more total writing space
than this page (page #4 in this packet). Short answers must be typed (single spaced, size 12
font – Times New Roman). Do not attach additional pages for the short answers.
1) Describe an ideal Christian residential community. Include your thoughts on what
makes a good Christian residential community.
2) How do you feel about taking on the role of an authority figure? What are some
lifestyle changes you will need to make to accommodate becoming a RA authority
figure? How comfortable are you being in a disciplinary role with people who you may
or may not know or who may be older or younger than yourself?
3) Building a strong and supportive RA staff is important. What do you believe you can
bring to a RA staff to help make it successful? What traits would your fellow RA staff
members need to possess to help you be a successful RA?
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