FERRUM COLLEGE SUMMER ENRICHMENT CAMP by sofiaie

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									                             FERRUM COLLEGE SUMMER ENRICHMENT CAMP
                                 COUNSELOR-IN-WAITING APPLICATION


NAME:                                                                    SOCIAL SECURITY NUMBER:__________________________
CURRENT ADDRESS:                                                         DATE OF BIRTH:                    AGE:____________
                                                                         CURRENT TELEPHONE:   _____________________________
                                                                         GRADE LEVEL IN SCHOOL:____________________________
EMAIL ADDRESS:________________________________________
NAME OF SCHOOL:                                                          CITY OR COUNTY:____________________________________

CLASSES YOU ARE TAKING THIS YEAR AND GRADES ON LAST REPORT CARD:                                                                             .

                                                                                                                                         .

HAVE YOU ATTENDED FCSEC AS A CAMPER?                                 IF YES, WHAT YEAR(S):___________________________________

OTHER CAMP EXPERIENCE: (As staff or camper)
 NAME OF CAMP                     ADDRESS                                DATES OF ATTENDANCE            NATURE OF ATTENDANCE




EMPLOYMENT/VOLUNTEER EXPERIENCE:
 SUPERVISOR                       NATURE OF WORK                                 DATES OF WORK                   TELEPHONE




OTHER EXPERIENCE: List membership in clubs and organizations, special training, and leadership experiences:
__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________

Camp T-Shirt Size---Adult   Small ____ Medium ____ Large ____ Extra Large ____ XXLarge ____

ATTACH A TWO-PAGE ESSAY TELLING ABOUT YOURSELF AND WHY YOU WOULD MAKE A GOOD C-I-W AT FCSEC.

C-I-W applicants must provide references from the following. Provide names and telephone numbers of people from whom you will be requesting
references.

                                                         Name of Reference                                 Telephone Number
  Principal or Guidance Counselor

               Teacher

            Adult Friend

            Adult Friend


                                                          Continuation on Back
As part of your duties as a C-I-W at FCSEC, you may be asked to assist with classes and workshops. To give us an idea of your interests and talents,
please check areas below that you could assist with. Space is provided to describe your special skills and experiences, where relevant.

                 AREA OF INTEREST                                     DESCRIBE SPECIAL INTERESTS, EXPERIENCES, ETC.

                               Crafts

                               Sports

                               Dance

                    Musical Instruments

                             Drawing

                               Drama

                          Photography

                      Foreign Language

                          Camp Songs

                                Other

                                Other




PLEASE SIGN BELOW AND RETURN THIS FORM NO LATER THAN APRIL 15, 2008. I CERTIFY THE INFORMATION GIVEN ON
THIS APPLICATION IS CORRECT TO THE BEST OF MY KNOWLEDGE.




SIGNATURE _____________________________________________________ DATE ____________________________________



                                                 MAIL TO: FCSEC COUNSELOR-IN-WAITING PROGRAM
                                                 C/O CHIP PHILLIPS, DIRECTOR OF SUMMER PROGRAMS
                                              P. O. BOX 1000, FERRUM COLLEGE, FERRUM, VA 24088-9001




   Ferrum College does not discriminate on the basis of race, religion, color, national origin, age, veteran status, gender or disability in admission to, access to, treatment in or
    employment in its programs or activities. The following person has been designated to handle inquiries regarding the nondiscrimination policies: Coordinator of Human
  Resources, John Wesley Hall 204, Ferrum College, Ferrum, VA 24088-9001, (540) 365-4235. Inquiries concerning the application of nondiscrimination policies may also be
              referred to: Regional Director, Office of Civil Rights, US Department of Education, 3535 Market Street, Room 6300, Philadelphia, PA., 19104-3326.

								
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