CSRA/LED Program Student Application

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* 1. Contact Information

First Name

Last Name

Address

City/Town

State/Province

ZIP/Postal Code

Country

Preferred Email Address

Cell Phone Number

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* 2. What is your gender?

Female

Male

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* 3. When were you born?

Birthday

Date

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* 4. Are you currently enrolled at BPCC?

Yes

Recent graduate

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* 5. What is the highest degree level that you are planning to obtain while at BPCC?

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* 6. When do you anticipate graduating from BPCC?

	Semester	Year
Semester/Year graduating	Semester/Year graduating Semester menu	Semester/Year graduating Year menu

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* 7. Indicate your military status.

Active Military

Veteran

Not a veteran (civilian)

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* 8. Indicate all benefits of the program where you would like assistance.

	Yes	No
Interviewing	Interviewing Yes	Interviewing No
Establishing effective study habits and learning techniques	Establishing effective study habits and learning techniques Yes	Establishing effective study habits and learning techniques No
Managing your schedule	Managing your schedule Yes	Managing your schedule No
Meeting employers	Meeting employers Yes	Meeting employers No
Obtaining an internship	Obtaining an internship Yes	Obtaining an internship No
Obtaining a job	Obtaining a job Yes	Obtaining a job No
Writing a IT resume	Writing a IT resume Yes	Writing a IT resume No

Other (please specify)

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* 9. What is your current employment status?

I am currently employed with an IT job.

I am currently employed with a non-IT job.

I am currently not working.

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* 10. If you are currently employed, enter the company's name. If you are not employed, enter "N/A".

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* 11. Have you ever been arrested?

Yes

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* 12. Have you ever been convicted of any felonies?

Yes

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* 13. The following boxes must be checked in order to join BPCC's CSRA/LED program.

I acknowledge and accept that by joining the CSRA/LED program, I am agreeing to fully participate in surveys that may request personal information (like in this application) and gather feedback that would be used for reporting purposes and to help document the progress of program outcomes. This agreement will be in effect while I am attending Bossier Parish Community College, after graduating, and during my employment with CSRA or any other company. The information that I submit on my application and surveys may be shared with the LED and CSRA.

I acknowledge and accept that by joining the CSRA/LED program, I am NOT guaranteed an internship or job with CSRA but will simply have more opportunities to prepare for such positions. It is my responsibility to make the most of my opportunities.

I acknowledge and accept that by joining the CSRA/LED program, I consent to receive program follow-up correspondence by email, text messages, phone calls, and/or social media.