Empower SCI Stony Brook: Clinical Specialist Application
Application as a Clinical Specialist for the two week residential program at Stony Brook University

Staff Training: July 13 and 14, 2019
Program Dates: July 14 to 27, 2019

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
Date of Birth *
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DD
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YYYY
What is your T-Shirt Size? *
Occupation *
Your answer
Will you need housing during camp? *
Emergency Contact *
Who can we call in the case of an emergency?
Your answer
Emergency Contact Telephone Number *
Your answer
Have you volunteered as a Clinical Specialist with Empower SCI's two week summer program in the past? *
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