APPLICATION for Eagle-Orzeł Educational and Cultural Exchange, Inc. Summer 2024 Camps
FOR RETURNING APPLICANTS
1. I am applying to be a
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Teacher
Teacher Aide
Peer Tutor (ages 10-17)
2. I am applying to be a volunteer at the camp in :
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Nowy Sącz
Otwock
Suwałki
Załęcze Wielkie
I have no preference.
3. Name (as it appears on passport)
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First Name
Middle Name
Last Name
4. Permanent Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
5. Primary Phone Number
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-
Area Code
Phone Number
6. Primary Email
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example@example.com
7. Date of Birth
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Month
-
Day
Year
Date
8. United States Passport Number - Applicants must be citizens of the United States and possess a valid passport with an expiration date not less that 6 months upon returning to the United States.
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If you do not have a passport, please write, 'currently applying'.
9. Passport Valid Until
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Month
-
Day
Year
Date
10. Name of Emergency Contact
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First Name
Last Name
11. Emergency Contact Relationship
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12. Emergency Contact Phone Number
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-
Area Code
Phone Number
13. Emergency Contact Email
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example@example.com
14. Emergency Contact Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
15. Have You Ever Been Disciplined or Charged for Insubordination, Incompetence, or Inappropriate Conduct while Employed?
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Yes
No
16. Have You Ever been Charged with a Felony or Misdemeanor?
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Yes
No
17. Have You Ever Been Arrested or Convicted of a Crime?
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Yes
No
18. If you responded "yes" to Questions 15, 16, or 17, please explain.
19. Please Upload a Head shot Photo of Yourself
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Browse Files
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of
20. Required Physician's Certificate
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Browse Files
Please upload the signed and stamped certificate found on our website. Only this certificate is acceptable. Please make sure that you also sign the certificate.
Cancel
of
21. Copy of Teaching Certification
Browse Files
Cancel
of
22. Please verify that you are human
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23. Agreement. By checking the box below, I hereby attest that all information provided in this application is true and that I assume responsibility for my responses. I authorize the Eagle-Orzel selection committee to process, review, and discuss my application materials.
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I agree.
24. By checking the box below, I understand that if I am accepted into the program and agree to participate in the program, I will pay the required fee of $300 for teachers or $250 for teacher's aides and peer tutors.
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I agree.
25. Signature
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26. Today's Date
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Month
-
Day
Year
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