Area of Interest Form Template

Area of Interest Form – (A Google Link will be provided to complete this form)

Student Information

1. First Name: _______________________________

2. Last Name: _______________________________

3. Chosen Name & Pronouns: _______________________________

4. Student ID: _______________________________

5. Centennial Email: _______________________________

6. Preferred Phone Number: _______________________________

7. Alternate Phone Number: _______________________________

Address & Commuting
8. Full Mailing Address (House/Apt #, Street, Region, Postal Code):

9. Main Intersection of Mailing Address (e.g., Warden & Lawrence):

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10. How will you commute to placement? (Vehicle or Transit):

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Placement Interests
11. Area of Interest #1: _______________________________
12. Area of Interest #2: _______________________________
13. Area of Interest #3: _______________________________

Languages & Accessibility
14. Do you speak any other language besides English? ☐ Yes ☐ No
15. If yes, what language(s)? _______________________________
16. Are you registered with CALCS? ☐ Yes ☐ No

Availability
17. Can you work shift work outside of 9:00 AM – 5:00 PM? (e.g., 3:00 PM – 11:00 PM) ☐ Yes ☐ No

Additional Information
18. Please share any additional comments or details that may help us match you to the best placement opportunity: