7th 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:  An annual weeklong camp sponsored by The Governor Morehead School Alumni Association to improve post secondary outcomes.    
When:  Sunday, July 26th to Saturday, August 1st (Staff arrive Saturday, July 25th).
Where:  The Governor Morehead School, NC State University & area businesses.
Why:  To provide an opportunity for youth with visual impairments to experience a glimpse of post secondary outcomes (careers, college, etc) through development of mentoring relationships with other visually impaired individuals, real world applications of college and career skills, and identification of available resources in the community.

SAMPLE ACTIVITIES:  
1. Self-advocacy course
2. Assistive technology
3. Riding public transportation
4. Sports and recreation
5. Career exploration
6. Visiting college campuses
7. Meeting and mentoring by employed persons with visual impairments.

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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.  Operations supervisors, dorm supervisors, and volunteers may be either sighted or visually impaired.  All positions require interviews.
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:
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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.
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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