Empower SCI: Residential Aide Application New York
Application as a Residential Aide for the two-week residential program at Stony Brook University (if you are interested in also applying for the Montana program, please select "Yes" in the final question on the application).

Instructions:

**New York**
Please complete and submit this form by March 31.
Notification of Acceptance: June 1.

NY Staff Training: July 11 and 12, 2020
NY Program Dates: July 12 to 25, 2020

Consider listing your "personal" email address here instead of a school or business account. Because of our volume of applicants, responses to school and business based emails are occasionally flagged as spam in our responses.
Email address *
Personal Information
Last name *
Your answer
First name *
Your answer
Telephone number *
Please include an area code
Your answer
Mailing address *
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
What is your T-shirt size? *
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