Counselor/Roadie/Security Information

IMPACT 2014 Counselor/Roadie/Security Information (Application attached)

I. Requirements and expectations to serve on the IMPACT staff:

 Counselors/security must currently be a college student.  Roadie must graduate from high school by June 2014  Counselors/Security/Roadie must have willing spirit to serve and an exemplary Christian attitude at all times.  Follow all IMPACT rules, guidelines and responsibilities as listed below.  Counselors/Security/Roadie must attend a training session that will begin Wednesday afternoon, June 11th  Counselors to be active in Christian community

II. Responsibilities for IMPACT staff:

Counselors

 Build relationships with your assigned group of campers  Model and enforce all IMPACT rules and guidelines  To do without complaining whatever Abbey, Walter or Shana asks you to do.

Security

 Serve and protect students  Model and enforce all IMPACT rules and guidelines  To do without complaining whatever Jimmy asks you to do.

Roadie

 Set-up for concerts, sessions, and all catered meals.  Unload and set-up, break down, and load entertainer’s equipment and merchandise.  Host entertainers and sell merchandise at concerts.  Serve as ushers for all sessions in the auditorium  To do without complaining what you are asked to do.

III. Protection Policy

Lipscomb University has adopted the following policies to provide additional security for our campers. These policies are primarily for the protection of our campers however, they also serve to protect counselors and leaders from false accusations of abuse.

 Two counselors are required on outings.

 One-on-one contact between counselor and camper is only permitted in situations that require a personal conference. Personal conferences should be conducted in view of other counselors and campers. Personal conferences not in view of other counselors and campers may take place only when special circumstances require. The counselor immediately shall inform an IMPACT leader of any such personal conference stating the camper’s name and the time and place of the conference.

 Counselors must respect the privacy of campers in situations such as changing clothes and taking showers, and intrude only to the extent that health and safety require. Counselors must protect their own privacy in similar situations.

Compensation

Counselors, Security and 2nd year Roadies  IMPACT Junior - $75  IMPACT Senior - $125  Tuition, Room, Board  Staff Shirt

Roadies -1st year  Tuition, Room, Board  Staff Shirt  The joy of serving others

The form on the following page must be filled out completely to be considered for employment. All information will be kept confidential.

Important Compensation Information

In order to be paid for working at IMPACT 2014, each worker that has not worked at Lipscomb before MUST complete a W-4, I-9 form (with required IDs), and, if you are a Lipscomb student, a Work Approval Form.

******If you want to receive your check when you leave IMPACT, you must have these forms completed and required documents above attached to the application and returned to our office no later than June 8. My fax number is 615-966-7634. IMPACT Application Complete this form and return to: IMPACT 2014, Lipscomb University, One University Park Dr. , Nashville, TN, 37204 Applying for:  Counselor  Security  Roadie Available:  Both  Junior Only  Senior Only

Please PRINT the following information: Name you prefer to be called:______Name: ______First Middle Initial Last Social Security Number (N/A for first year Roadies) ______

Email Address: ______Check your email regularly for information and updates.

Cell Phone: ______Emergency Contact Number: ______Another Phone # where you can be contacted: ______

School Information

School Name: ______City: ______State: ______

Home Address

Address: ______

City: ______State: ______Zip: ______

Date of Birth: ______/______/______Gender: ______Male ______Female

T-shirt Size: ____S ____M ____L ____XL ____XXL

Month and year of high school graduation: ______, ______

Are you a Christian? ______Yes _____No Church presently attending:______Home church: ______Youth Minister: ______Phone Number: ______

Are you planning to be a summer intern? ______Yes _____ No If yes, with whom? ______

Are you planning to come to work with a particular group? Group Name: ______Are you planning to attend summer school at Lipscomb? _____ Yes _____ No

Have you attended IMPACT in the past? ______Yes _____ No

Have you been an IMPACT counselor or security person before? _____ Yes _____ No When? ______

List previous experiences you may have had as a counselor, security person, or roadie:

Why do you want to be an IMPACT counselor, security person, or roadie?

Do you have a medical condition that could affect your ability to serve as a counselor, security person, or roadie? _____ Yes _____ No If yes, please explain:

Are you taking prescription drugs? _____ Yes _____ No If yes, please list:

Have you ever been convicted of a crime other than a minor traffic violation? ___ Yes ___ No If yes, please explain:

Please list two adults unrelated to you as references. You MUST include phone number .

Name: ______Phone #: ______

I verify that the information I have provided in this application is true and correct as of the date indicated by my signature below. If any information changes, I will immediately notify the IMPACT director in writing of any such changes.

I verify I will abide by all counselor requirements, responsibilities, and policies as specified in this application, as supplied at training sessions and as supplied during the camp session.

I understand that in applying for an IMPACT staff position, the information I have furnished on this application is subject to a background check and verification. I affirm that all statements and information in this application, to the best of my knowledge, are true, correct and complete.

______Signature of applicant Date

Printed Name