YCSA Representative Application

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Name* This field is required.
First Name
Last Name
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Supervisor Approval* This field is required.
Approved
Not Approved
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YCSA Representatives are the liaisons between the YC Staff and the YCSA Leadership Team. You will need to be able to fulfill the following YCSA Commitments:

1. A minimum of five hours per month for YCSA duties

2. A two-year term, as long as you are employed by YC
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YC Email* This field is required.
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YC Phone #* This field is required.
Area Code
Phone Number
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Are you an exempt or non-exempt employee?
Hourly - Non-exempt (Full-time and/or Part-time)
Exempt
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Years of employment at Yavapai College:* This field is required.
0 to 3 years
4 to 7 years
8 plus
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Are you currently serving or will be serving on any YC Committee(s) for 2022 through 2024?* This field is required.
YESNO
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Please list the committees that you are or will be serving on during 2022 through 2024:
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What division of Yavapai College do you work under?* This field is required.
Dr. Clint Ewell, Finance and Administration Services
Mr. Rodney Jenkins, Student Development & Community Relations
Dr. Ryan, Academic Initiatives/Spec Projects
Dr. Rhine, President
Dr. Emily Weinacker, CHRO
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Statement of Interest* This field is required.Please provide a brief statement of why you are interested in representing your division/department. (50 words or less)
Huge
Large
Normal
Small
Ok
Ok
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Supervisors Name:* This field is required.
First Name
Last Name
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Supervisors Email* This field is required.Your application will be forwarded to your Supervisor for approval. (time and work commitment)
example@example.com
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Your understanding* This field is required.
I have read, understand, and accept the requirements for a YCSA Representative.
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Once you submit your application, it will go to your supervisor for approval (time and work commitment).

Thank you!
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