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

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

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
What is Your T-Shirt Size? *
Will you need housing during camp? *
Are you CPR certified? *
Examples: American Heart Association BLS for Healthcare Providers, American Red Cross Basic Life Support for Healthcare Providers, Health and Safety Institute BLS for Healthcare Providers and Professional Rescuers
If not CPR certified, are you willing to become CPR certified prior to Staff Training if accepted into the program?
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 Res Aide with Empower SCI's two week summer program in the past? *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service