Incomplete or Overly Brief Apllications Will Not Be Considered

Full Name: Age (not required):
Email Address: How did you hear of C.W.:

Address At School: Until: (Date)
City: State: Zip:
School Phone #: Cell Phone # :
Latest Time To Call:

Parents/Home Address: (get starting April 1st)
City: State: Zip:
Parents/Home Phone #: Cell Phone # :
Latest Time To Call:

School: Major:

Current Year:
Freshman Sophmore Junior Senior Graduate Student
Salary Desired (2 months includes room and board):

Describe what activities you would like to teach and explain your
background and experience in each.

On the following list, put numeral "1" before activities you are highly skilled in and think you can teach to children, "2" for activities you are skilled in and have experience as a participant, and "3" for other areas you have interest working in. Leave blank if you have no interest in the activity.

Do you hold American Red Cross Certificates: Give dates of certificates.