8th annual Envisioning Youth Empowerment Retreat Staff Application
BASIC INFORMATION ABOUT THE EYE RETREAT:
Who:  Youth with visual impairments who want to learn about college and careers.
What:  A week long camp that provides an opportunity for mentoring and resource sharing by current college students and workers with visual impairments.
When:  Saturday, July 23rd to Saturday, July 30th (Staff arrive Friday, July 22nd).
Where:  The Governor Morehead School, NC State University & area businesses.

SAMPLE ACTIVITIES:  
1. Self-Advocacy
2. Assistive Technology
3. Public Transportation
4. Sports and Recreation
5. Job Shadowing
6. College Campus Exploration
7. Mentoring
8. Time Management

Position Descriptions:

1.  College Coordinator is responsible for group leaders within their track, class observations, class lesson planning, and participant supervision.  This person is on duty from 7am to 6pm and shares in an evening rotation for supervision.
2.  Career Coordinator is responsible for group leaders within their track, securing work site job experiences, class lesson planning, and participant supervision.  This person is on duty from 7am to 6pm and shares in an evening rotation for supervision.
3.  Registration, Recreation and Transportation Coordinator is responsible for arranging transportation to and from sites, arranging transportation for recreational activities, collecting and reviewing registration documents, completing check in and check out with participants, and arranging and supervising recreation activities.  This person is on duty during all registration times, during all check outs, and each evening during the week.
4.  Dorm Coordinators are responsible for overnight supervision of participants, ensuring cleanness of dorms, assisting with serving of breakfast, serving as point of contact during overnight hours, and ensuring participants adhere to the schedule.
5.  Senior Group Leaders are responsible for assisting track coordinators with supporting group leaders, serving as track leader in the absence of the track coordinator, teaching of assigned classes, supervising participants, serving as a mentor, and assisting with meal duties.  These individuals are on duty from 7am to 6pm.  Each group would have about 4 participants.
6.  Group Leaders are responsible for teaching of assigned classes, supervising participants, serving as a mentor, and assisting with meal duties.  These individuals are on duty from 7am to 6pm.  Each group would have about 4 participants.
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Name (first and last) *
Address (street, city, state, and zip code) *
I am applying to be a: *
All coordinators, senior group leaders, and group leaders must have a visual impairment.   Dorm supervisors and volunteers may be either sighted or visually impaired.  All positions require interviews.  We reserve the right to conduct criminal background checks and contact references.
Required
How old are you? *
What is your home phone number? *
What is your cell phone number? *
What is your email address? *
I am currently: *
Required
I consider myself to be: *
Gender: *
My t-shirt size is: *
Do you have any medical conditions besides blindness (be specific)? *
Do you have any food allergies or restrictions (be specific)? *
Do you take any medications (be specific)? *
Do you require any other accommodations to participate (be specific)? *
How do you access printed material? *
Required
In a short paragraph, please tell us why you wish to attend the EYE Retreat. *
In a short paragraph, please tell us what skills you can bring to the EYE Retreat. *
In a short paragraph, please tell us about your leadership experience. *
At the EYE Retreat we encourage our staff to lead classes on topics of interest to them.  Please choose your top three choices from the list below or use “other” to suggest a new class. *
Required
Please provide contact information for a friend or family member in the event of an emergency. *
Name, phone number(s), and relationship to you.
Please provide contact information for two references.  These individuals should not be friends or family members.  They could be teachers, professors, supervisors, mentors, or other professionals. *
Name, phone number(s), and relationship to you.
Please describe here if you have ever been charged with a crime, convicted of a crime, suspended or expelled from work or school, asked to resign from a position, or been disciplined for violating established policies. *
If none of the above apply to you write "not applicable" below.  If any of the above applies to you, please describe the circumstances surrounding the incident.  Please note that disclosure of any of the above items does not automatically exclude you from being part of the EYE Retreat.
Is all the information you have provided on this form true and accurate? *
Print YOUR name here indicating you are submitting this form with true and accurate information. *
Parent/Guardian print YOUR name here if staff applicant is under the age of 18 indicating your are submitting this form with true and accurate information and that you give permission for your son/daughter to submit this application.
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