Application for the Software Testing and Development Lab

Name:	Date:
Address:
E-mail Address:	Phone:
Major(s):	Minor(s):	Advisor:
Country of Citizenship	Expected Graduation Date:
Birth Date:	Can you work summers:	How many hours?
Can you work 10-15 hours a week during school?	Do you have another campus job?
Are you involved in other activities (sports, jobs, etc.)? If so list and give amount of time you spend on each.
Do you plan on enrolling in a CS Practicum? If so, when?

List all CS and Math Courses you have taken or attempted

Course #	Name	Term	Grade	Instructor	Repeat?

List other CS or special skills you may have, i.e., PC's, Java, etc. Where did you get these skills? Rate your skills on a scale of 1 to 5.

Do you know anyone who works in the Testing Lab? If so, who?

Attach a copy of your transcript, your current class scedule, a photo of your student ID card, and submit application to Dr. Cichanowski or Ms. Sue McDonnell.
Please list any additional information you would like to provide on the back.