Summer Program Counselor Application
Please consider me for the following summer programs:
______ AgriTREK/SciTREK Summer Institute/AgDiscovery/DiscoveryTREK (Early to Mid-June)
______Forestry and Natural Resources (FNR) Day Camp (Late June)
______FNR-TREK/GREP (Early to Mid-July)
1. Contact Information: Please note where you wish to receive mail and through what date you will reside there.
Name: ____________________________________________
SS#: _____________________________________________
Permanent address: __________________________________
Length of time? ____________________________________
City: _____________________________________________
State: _____________ Zip: ___________________________
Phone: ____________________________________________
Email Address: _____________________________________
Temporary address: _________________________________
Length of time? ____________________________________
City: _____________________________________________
State: _____________ Zip: ___________________________
Phone: ___________________________________________
Email Address: _____________________________________
College: ___________________________________________
(Expected) Graduation Date: __________________________
Major: ____________________________________________
Minor: ____________________________________________
2. References: These should correspond to the persons completing your reference forms.
Name: ____________________________________________
Position: __________________________________________
Address: __________________________ City: ___________
State/Zip: _________________________________________
Phone: ____________________________________________
Email Address: _____________________________________
Name: ____________________________________________
Position: __________________________________________
Address: __________________________ City: ___________
State/Zip: _________________________________________
Phone: ____________________________________________
Email Address: _____________________________________
Name: ____________________________________________
Position: __________________________________________
Address: __________________________ City: ____________
State/Zip: _________________________________________
Phone: ____________________________________________
Email Address: _____________________________________
3. Questions: Please provide answer for the following questions:
A. Have you ever been through a counselor / teacher training program? __Yes __No
If yes, please describe the program, including length of the program and location. __________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
B. What camp/camping or leadership experience do you have? _________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
C. Why are you interested in this position? _________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
D. What do you consider the most important elements of a residential summer enrichment experience? _________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
E. Do you have any experiences working with children? If so, how what age and for what length of time? _______________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
F. What contributions can you make to benefit the program? ___________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
4. Skills Assessment: Please circle the areas in which you have:
1) no knowledge or experience 2) basic knowledge or experience 3) advanced knowledge or experience 4) teaching experience.
Not all items apply to all jobs.
Creative Writing
1234
Outdoor Games/Recreation
1234
Creative Drama/Theater
1234
Painting/ Drawing
1234
Engineering
1234
Photography/Videography
1234
Musical Instrument (type: _________________)
1234
Song Leading
1234
New Games
1234
Storytelling
1234
Tuskegee University History
1234
Tent camping
1234
Orienteering/Map Reading
1234
5. Other:
Do you have a valid driver's license? ________Yes ________No Which State? ____________ License No: __________________________
Have you been convicted of a crime in the last 7 years? ________Yes ________No
If yes, explain below. If necessary, use a separate sheet (a conviction will not automatically preclude you from employment)
6. Verification and Authorization:
I hereby authorize College of Agriculture, Environmental and Natural Sciences (CAENS) Tuskegee University to contact, obtain, and verify the
accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release
from liability (CAENS) Tuskegee University and its representatives for seeking, gathering, and using such information to make employment
decisions and all other persons or organizations for providing such information. I understand that any misrepresentation or material omission
made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am
employed, whenever it may be discovered. If I am employed, I understand that I will be employed at-will, and that my employment can be
terminated without cause and without notice, at any time. I understand that no employee, supervisor or representative (CAENS) Tuskegee
University has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to
my employment at-will.
I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability
because of that person’s need for a reasonable accommodation to perform the essential functions of the relevant job, as required by the director of
AgriTREK Summer Institute. I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work
authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of
employment.
I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.
Signature: ____________________________________________________________________ Date: __________________________________
Print Name: __________________________________________________________________ Phone: _________________________________
Application deadline is April 1 annually; applications received by May 1 will be considered for
FNRTREK/GREP only.
Completed applications should be mailed to Marilyn Hooks, Program Assistant, AgriTREK/SciTREK Summer Institute and
AgDiscovery Program, 103 Mary Starke Harper Hall, Tuskegee University, Tuskegee, AL 36088
Tuskegee University is an equal opportunity employer. We consider applicants for all positions without regard to race, color, religion, gender,
national origin, the presence of a non-job-related medical condition or handicap, or any other legally protected status.