2022 Envision Blind Sports Counselor/CIT Application
July 17th - 23rd at Penn State Behrend- Erie, PA
July 16th- Mandatory Training Day
Room & Board covered for all full-time volunteers
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Name: (First/Last)
Date of Birth:
MM
/
DD
/
YYYY
Age:
Gender:
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Street Address (college students- please list home address):
City & State:
Zip Code:
Cell Phone Number:
Email Address:
Availability:
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If part-time, what is your availability?
T-Shirt Size:
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Do you have experience working with individuals who are blind or visually impaired?
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Please explain your previous experience working with individuals who are blind or visually impaired:
Please explain why you are interested in becoming a counselor for the 2022 Envision Blind Sports Summer Camp:
Please check if you are interested in taking on a leadership role in any of the following areas:
*Please note: Please only check boxes for sport/activities you have prior experience coaching. Also, just because you check the box does not mean you are guaranteed the leadership position. This question is to gauge interest for potential placement.
If you selected a leadership role, please explain your past experience:
Are you comfortable on a high ropes course?
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Are you a certified lifeguard?
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