Please provide 3 references (personal and professional): Name, e-mail, phone number
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Full Name
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Date of Birth *
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Phone number *
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Email Address *
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Mailing Address *
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Will you need housing during the program? *
Which description(s) best describe you? *
Required
Teaching/Volunteer Experience
Please provide a brief description of your experience working with children, including those with VI/blindness.
*
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Would you be willing to submit to a background check?
*Please note you will NOT be accepted without a cleared background check.
*
Required
In which area(s) are you willing to volunteer? *
Required
Why did you chose the area(s) above? Please provide any details I should know about your expertise in these areas. *
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Time Commitment
Please indicate your commitment level to the program. .
*
Required
Days and hours I can commit
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Extra
Is there anything else that we should know about your or that you would like to share?
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Organization Affiliation
If you are representing an organization, please provide the following information: Organization Name, Address, City, State, Zip, person in charge of volunteer project and phone number.
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Shirt Size *
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Dietary Information
Please indicate dietary limitations (Please note that you may need to bring some of your own food if you have very specialized needs). Volunteers are always free to eat any of the meals served in the program.
*
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Medical Information
Please note: This information will be kept confidential. Please let us know any medical conditions that we should be aware of since you will be on campus. Please include any daily medications, as well as your insurance information and emergency contacts.