George Mason University

Name:

Phone:

E-mail:

G#:

Will you live on campus during the 2012-2013 academic year?:  Yes No

Student Status:  FR SO JR SR

Cumulative GPA:

Are you in good judicial standing?:  Yes No

If not, please explain:

Will you have any other jobs or an internship during the 2012-2013 academic year?  Yes No

If yes, please describe:

Why are you interested in this position?:

What qualities do you possess that will enable you to be an effective Film Assistant?:

Programming/Leadership Experience:

Please list any Student Involvement areas you have been involved in and any events you have assisted with, planned, or attended:

Do you have work study that you would use for this position?  Yes No

If yes, what is your work study award allocation per semester?

Reference 1:

Name:

Title:

Relationship:

Phone Number:

Reference 2:

Name:

Title :

Relationship:

Phone Number: