CPW Volunteer application 2015
Facilitator/Volunteer Information & Application Camp Dates: July 13 – 17, 2015 Training Dates: Thursday, June 18, 1 to 7 PM And Friday, June 19, 9 AM to 3 PM Name:___________________________________ Professional/CommunityAffiliation:______________________________________ Phone:________________________ Email:________________________________________________ Address:______________________________________________ City, state, zip__________________________________________ Please note: Answers to the following questions are not mandatory, but are of interest to us in the spirit of recruiting a diverse team of individuals for involvement in CampPeaceWorks. Do you… …*identify as: Male Female …*identify as: Heterosexual Gay Lesbian Other_____________________ …*identify as: White Black Hispanic Bi/Multi Racial Native American Asian___________________ Other______________________________________ …*identify as: 18-24 25-34 Trans-gender 35-44 Bi-sexual 45-54 55 – 64 65+ How would you like to be involved? I am interested in being part of the Facilitation Team. I understand that members of the Facilitation Team are responsible for setting the camp schedule and agenda, enhancing existing curriculum and participation in program delivery during camp. Members may be Conocimientos Group leaders and/or “camp counselors.” They may also assist in recruiting additional team members and campers, marketing activities, and obtaining community buyin. Attendance at a two-day training is required. I understand that I will be asked to attend, when possible, regular meetings related to these responsibilities.* I am interested in being part of the Camp Support Team. I understand that the Camp Support Team consists of individuals willing to serve as “camp counselors,” Conocimientos Group leaders, activity, song, ice-breaker or recreation leaders, or may contribute something specific, such as facilitating a drum circle. The Camp Support Team may assist in camper recruitment. If possible, Camp Support Team members will attend a two-day training.* I am interested in being part of the General Volunteer Team. General volunteers may perform any number of duties, including registration & check-in; meal preparation, serving or clean-up; general errand-running when needed; water and snack replenishment, and others to be determined. * *Involvement on any of the above teams requires clearances. See page 3 Your Skills & Interests Describe your interest in CampPeaceWorks. What skills, experiences or areas of interest do you bring to the table? PeaceWorks and CampPeaceWorks are projects of Berks Women in Crisis 255 Chestnut Street ! Reading, PA 19602 ! 610.373.1206 [email protected] ! Additional questions or comments (may attach separate sheet): Additional Contact Suggestion(s): Can you think of someone who might be interested in involvement with CAMPpeaceworks? Please provide us with their name and contact information: Name:__________________________________________________ Community/Professional Affiliation:_________________________ Phone:__________________________________________________ Email:__________________________________________________ Address:________________________________________________ __________________________________________________ __________________________________________________ Please Return This Application to: Berks Women in Crisis Attn: Tasha Isaac; c/o CAMPpeaceworks 255 Chestnut Street Reading, PA 19602 PeaceWorks and CampPeaceWorks are projects of Berks Women in Crisis 255 Chestnut Street ! Reading, PA 19602 ! 610.373.1206 [email protected] ! Have you undergone mandated reporting training since the change in laws, January 2015? Yes No Do you have a Criminal Background Check clearance? Yes If so, is it dated August 2012 or more recent? Yes No Do you have a ChildLine clearance? Yes If so, is it dated August 2012 or more recent? No Yes No No Do you have a current FBI clearance? Yes No Have you lived in Pennsylvania throughout the past ten years? Yes No A criminal background check, a ChildLine clearance and an FBI clearance (if you have not lived in Pennsylvania throughout the past 10 years) or a Volunteer Verification Form (available in our office), must be on file prior to training for CAMPpeaceworks. Applicants unable to provide clearances (we can help you) by the training date, will not be able to facilitate at CAMPpeaceworks. PeaceWorks and CampPeaceWorks are projects of Berks Women in Crisis 255 Chestnut Street ! Reading, PA 19602 ! 610.373.1206 [email protected] !
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