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Five Quad VAS Spring 2017 Application
*IN ADDITION TO THIS APPLICATION YOU MUST ATTEND A GENERAL INTEREST MEETING AND SIGN UP FOR AN INTERVIEW TO BE CONSIDERED

General Interest Meetings:
Tuesday January 31st 8pm Location State Quad Penthouse
Wednesday February 1st 8pm Location State Quad Penthouse

Please answer all questions below honestly and to the best of your ability! This application is due on February 2nd at 11:59pm.
* Required

Full Name: * First and last name
Your answer

What is your expected date of college graduation?(semester & year) *
Your answer
Email Address: * Make sure this email is valid and one you check frequently.
Your answer
What is your phone number? *
Your answer
Please list Major(s)/Minor(s) * Please note that we encourage ALL majors to apply!
Your answer
Have you applied before? If so, when? *
Your answer
Please list any other clubs/sports/jobs/etc that you are involved in including any leadership positions: *
Your answer
Please list any past leadership experiences: *
Your answer
Can you handle your course work and time committed to Five Quad along with any other outside commitments? *

Your answer
What are your future career and educational plans/goals? *
Your answer
Please list any patient care experience or certifications: * Please note we don't require any experience to join Five Quad. If you have any certifications, please bring them to your interview. If you are an EMT or firefighter, you must provide certification.
Your answer
What are some of your hobbies? *
Your answer
Why do you want to join Five Quad Volunteer Ambulance Service? *
Your answer
How did you hear about Five Quad? *
Your answer
Are you willing to commit the time to complete a MIT semester which will include: all trainings (mostly on Sunday nights), CPR/First Aid weekend, membership meetings, a group presentation, some Five Quad events, CEVO training, and coming in on your own time to complete a MIT packet? * Please list any possible conflicts.
Your answer
Have you ever been convicted of a misdemeanor or felony? *
Your answer
If you answered yes, please explain:
Your answer
Please list at least one reference (can be professional or peer): * Include name, telephone number, and email address of reference.
Your answer
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