Application

Note: Please be sure to complete all sections of this application. Incomplete applications will not be considered. If you have any further questions about the Wellness Living Learning Community, feel free to contact Tywanna Purkett at (252) 328-5771 or at purkettt@ecu.edu.

First Name:

Last Name:

Middle:

Banner I.D.:

Sex:

Male

Female

Mailing Address:

City, State, Zip Code:

Home Phone Number:

Cell Phone Number:

Best number to reach you::

Home

Cell

ECU Email Address:

Alternate Email Address:

Name of High School:

Intended Major (if known):

Shirt Size:

Small

Medium

Large

2XL

How did you hear about the WLLC?:

What work or volunteer experience have you had that is related to health and/or wellness?:

Volunteer Experience:

As part of completing this application, you must submit one letter of recommendation. Please provide us with the name of one person who is writing a letter of recommendation on your behalf. The person can be your guidance counselor, teacher, supervisor, organization advisor, etc. Name of Reference Phone Number How does this person know you?

References:

(answer in 250 words or less) Why do you wish to be a member of the WLLC? Please include the following: Contributions you expect to make as a member of the community. What you hope to gain by being a member of the community. Any outside interests that have influenced your desire to apply. Any programming ideas you may have for this opportunity.

Short Essay: