SAMA Program
Austin Peay State University
Application: SAMA Group Leader
Please answer the following questions: (please print)
Full Name: ___________________________________________________
Contact Information:
Summer Residence Telephone: _______________
Cell Telephone:
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Alternate Contact Telephone: _______________
If you live on campus, what is your summer campus address?
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Collegiate Classification after Spring Semester:
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Current cumulative GPA:__________
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Major:
Questions:
What qualities do you possess that we should consider when reviewing your
packet for the SAMA program?
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How do you see yourself influencing high school students?
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List your direct leadership experiences?
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Describe your leadership skills, specifically with working with others. How
do you manage difficult situations or people?
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What risks do you foresee while working with high school aged
participants?
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Use three (3) adjectives to describe yourself
1._____________________________
2._____________________________
3._____________________________
Do you possess technological skills to create DVDs and other Video-media?
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Have you ever been involved in any disciplinary or criminal activity?
Yes _________ (please specify)
No ___________
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Do you grant us permission to conduct a criminal background check?
Yes ________
No ___________
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Signature
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Date
Deadline for returning this application each year is:
May 14, 20
.
All applications must be hand delivered to Dr. Willodean Burton, SSC
A127 by the deadline listed above.
Remember to complete the APSU Employment Application – go to HR
website.