Complete this form and include your letter of recommendation and transcript from your college or university. This application will be sent to the CAWV for review. You may be contacted to provide more information. If no transcript or letter is provided now, you may mail them to: 2114 Kanawha Boulevard East, Charleston, WV 25311, or call 304-342-1166. All fields are required except for employment history and secondary college information.  

PERSONAL INFORMATION

  First Name
 Initial
 Last Name
 
  Date of Birth

  Social Security Number
HOME ADDRESS INFORMATION

  Email Address

 Number & Street
 
  City
  State
  Zip Code
SCHOOL ADDRESS INFORMATION

 Number & Street
 
  City
  State
 Zip Code

 
  Phone Number @ Home
  Phone Number @ College
SCHOLASTIC INFORMATION
  College Attended (1):

  College Name
 Dates Attended
 
 Major
 Graduated Date (or Anticipated)
  College Attended (2):

  College Name
 Dates Attended
 
  Major
 Graduated Date (or Anticipated)

  Major of Study
Current Status : Sophmore    Junior
Overall Grade Point Average :
Based on "A"=4.0
Which Elligible College Do You (Plan To) Attend? : West Virginia University
WVU Institute of Technology
Fairmont State 
Bluefield State
Other   
Major Field of Study At Elligible College or University :
EMPLOYMENT HISTORY
List work experience beginning with most recent employment, including summer work.
--- Job 1 ---
Dates : (From)   (To)
Company Name :
Type of Business :
Address :
Immediate Supervisor :
Phone Number :
Duties :
--- Job 2 ---
Dates : (From)   (To)
Company Name :
Type of Business :
Address :
Immediate Supervisor :
Phone Number :
Duties :
--- Job 3 ---
Dates : (From)   (To)
Company Name :
Type of Business :
Address :
Immediate Supervisor :
Phone Number :
Duties :
--- Job 4 ---
Dates : (From)   (To)
Company Name :
Type of Business :
Address :
Immediate Supervisor :
Phone Number :
Duties :
FILE ATTACHMENTS
Letter of Recommendation :
Transcript :