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: __________