Protect Our Pack Application

Apply to be a Pack Leader!

Step 1 of 2

Name

First Name, Middle Initial, Last Name

Pronouns

(She/Her, He/Him, They/Them, etc.)

Student ID

8-digit PeopleSoft Number

Phone Number

e.g., jonathan.husky@uconn.edu

Home Address

Address, Town, State, Country

Your School/College at UConn:

Major(s), Minor(s)

GPA (Cumulative)

Semester Standing (Completed)

Campus

Date of Expected Graduation

Language(s) spoken other than English

Please list three references who are able to comment on your qualifications for this position. You may list current Pack Leaders as references.

Reference 1

Name, Title, Phone Number, Email

Reference 2

Name, Title, Phone Number, Email

Reference 3

Name, Title, Phone Number, Email