KENTUCKY STATE UNIVERSITY

Student ID# Last: First:

Phone #: Email:

Supervisor: Once student has been selected for the position, please complete, and return to the FWS coordinator to complete the HR process (background check and ADP access)

Department/ Location

FOAP

Student position title

Student's supervisor

Supervisor Email

Supervisor Phone number

Student's Schedule

Monday Tuesday Wednesday Thursday Friday

Student Signature: ________________ Date: __________

Supervisor Signature: ________________ Date: __________