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2023 IMPACT Counselor Application
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Middle Initial
Your answer
Last Name
*
Your answer
Name you preferred to be called
*
Your answer
Select One
White/Caucasian
Black/African American
Hispanic/Latino
Asian
Other:
Clear selection
Are you available to be here for the mandatory IMPACT Training June 14-16?
*
Yes
No
I am applying to work at:
*
IMPACT Junior only
IMPACT Senior only
Both
What is your previous IMPACT Experience?
*
None
Counselor
Roadie
Security
If so, what year(s) Check all that apply
2022
2021
2020
2019
Other:
Email address
*
Your answer
Cell Phone
*
Your answer
School Name
Your answer
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