STUDENT _SAMPLE_____________________  SUPERVISOR_SAMPLE_________________

WORK PLACEMENT __MARTIN_____________ BUILDING __MARTIN_______________

DATE AND TIME TO REPORT ________August 1, 2003______________________________

R.U. ID Number __000000______________

The number of hours to be worked per fifteen week semester is:

___ ___ hours at _______ per hour, not to exceed _________ per semester

___ ___ hours at _______ per hour, not to exceed _________ per semester

I hereby accept the above employment for the ____________________________, and promise to perform the duties of this position to the best of my ability. I agree to notify the Financial Aid Office immediately if I terminate my employment. I understand that should I not report to my supervisor on the date indicated, my employment can be canceled. I further understand that should I not cooperate with my supervisor and perform the duties of this position to the best of my ability, my position can be terminated.

I agree to maintain full-time status, carrying 12 or more hours per semester. I realize that my assignment will not be changed unless an extreme circumstance warrants it.

COMPLETE ONE OF THE FOLLOWING:

I. Accept the agreement. Give this form to your supervisor when you report to work. You must also show him or her a copy of your class schedule.

II. Reject the agreement. Return this form to Financial Aid Office immediately.

TO THE SUPERVISOR: Please sign the statement below and return this form to the Financial Aid Office.

The student has reported to me and has shown me his or her class schedule.