Counselor Application

If you prefer to complete a hardcopy of this form, you can download the counselor application.

Applicant's Name:

Application Date:

Student ID#:

Date of Birth:


Male Female

Campus Address:

Local Mailing Address:

Email Adress:

Phone Number:



GPR Last Semester:

Cumulative GPR

Number of Semesters at Clemson University

Number of Semesters in University Housing

Anticipated Graduation Date

Have you had RA experience?

If “yes”, please describe:

What experiences and/or skills do you feel you have to contribute to the Summer Program for Research Interns at Clemson University? Please include any emergency or medical certification (e.g., CPR, First Aid)

Will you have other part-time work, internships, student teaching, etc. summer?

If “yes”, please describe:

Will you be taking one or more courses this summer?

If “yes”, list courses, summer session and anticipated meeting times:

Two letters of reference: one from University faculty/staff and one from a recent employer are required and must be submitted before your application is considered complete. Please list the names, relationship and email address of the people that will be writing a letter of reference on your behalf. Letters must be mailed or emailed directly to Cora Allard-Keese. Two university members are allowable if you have no recent employer.


To complete the application process, please submit a resume (including all past work experience, internships etc) to Cora Allard-Keese at Applications will be considered complete when resume and application are received.