Federal Work-Study Employer Interest Form

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Thank you for your interest in the Federal Work-Study Program. Please complete all of the information below. Work-Study placement and availability are dependent upon funding.

Agency Name

Department Name

Position/Classification of Job Title

Position Location

Supervisor Name

Supervisor Phone

Supervisor Email

Secondary Supervisor Name

Secondary Supervisor Phone

Secondary Supervisor Email

Agency Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Non-profit or For-profit

Agency’s Mission Statement and Description of Clients Served

How many student jobs may be available at your agency during the next Academic Year? (August - May)

How many student jobs may be available at your agency next summer? (Late May-July)

Job Description

Department Description

Responsibilities

Qualifications

Physical Requirements (if applicable)

Special training or additional requirements (if any)

Pay Rate

Length of Employment: Academic Year

Work Schedule (Days/Hours)

Student evaluations must be completed and returned to the Work Study coordinator by the end of each semester.

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Federal Work-Study Employer Interest Form