Work Based Learning Assistant

Complete, compile and submit the enclosed application materials in coordination with your CLO/Advisor.

Deadlines: 

      Fall Session:  Mid-September
      Spring Session:  Mid-October 

Please contact Student Programs for exact deadline dates, as they are subject to change. Questions should be directed to the Senate Office of Student Programs. 
Tel: 518-455-2611 Fax: 518-426-6827 [email protected] | nysenate.gov/student-programs

  • Form
  • Student Statement
  • Statement of Purpose
  • Complete

New York State Senate Application
Work-Based Learning Program

Session
Name
Home Address
Mailing Address
Type Phone Number Weight
more items
List all high schools you have attended, beginning with the most recent.
Name of School Date of Attendance Major/Minor Diploma, GED, Certification Degree Sought Date of Graduation Overall GPA (4.0 Scale) Weight
more items
Preferred Placement Area
Special Skills
If you have experience/knowledge in any of the areas below, please check the corresponding box. Inexperience does not preclude participation in the program.
Course Credits: Are you participating for course credits?
Provide a reference from a person familiar with your academic abilities.
Name Position/Title Institution Direct Telephone Number Weight