APPLICATION for Eagle-Orzeł Educational and Cultural Exchange, Inc. Summer 2025 Camps
For NEW APPLICANTS
1. I am applying to be a
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Teacher
Teacher Aide
Teacher Aide with Parent (16-17)
Peer Tutor (10-15)
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
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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
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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. Educational Background
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Please indicate earned degree(s) with completion date and name of institution. If currently in college, indicate major/minor and institution attending. If not attending college, please list the last institution attended.
16. Professional Teaching Experience
Please list teaching experience beginning with current position.
17. Other Professional/Work Experience (Including volunteer service)
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Place of Employment/Organization/Location/Position/Dates
18. Please List other Experiences, Travel, and Activities Which You Consider Relevant To Teaching English, Leadership Topics, and/or the Arts Outside the United States.
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19. List Suggestions for Extracurricular Activities You Would Be Able to Organize and Lead at the Camp.
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20. List Honors, Publications, and Achievements.
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21. List Memberships/Participation/Leadership in Educational, Cultural, Extracurricular, Civic and Other Organizations.
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22. Why Do You Want to Participate in this Program?
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23. How Did you Hear about This Program?
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24. Do you have Polish heritage? NOTE: Polish ancestry is NOT required for participation in this program.
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Yes
No
25. What Qualifications and Traits Do You Have that Especially Qualify You for Participation in this Program?
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26. Lesson Plan For Teacher Applicants:
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Please develop and submit a sample lesson plan that you might use in this program.
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27. Have You Ever Been Disciplined or Charged for Insubordination, Incompetence or Inappropriate Conduct while Employed?
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Yes
No
28. Have You ever been Charged with a Felony or Misdemeanor?
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Yes
No
29. Have You Ever Been Arrested or Convicted of a Crime?
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Yes
No
30. If you responded "yes" to Questions 27, 28, or 29, please explain.
31. Please Upload a Head shot Photo of Yourself
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32. 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.
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33. Copy of Teaching Certification
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For teachers only.
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34. Do you have a current and valid background check?
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Yes
No
35. Please upload your current CV or resume.
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36. Recommendations - Please provide the name and e-mail addresses of two individuals that you have contacted to serve as professional references for you. Recommenders should complete the recommendation form available here by February 28, 2025 https://form.jotform.com/242688393992173. Kindly share this link with your recommenders. The selection committee takes the reference forms very seriously. If your reference forms are not received by February 28, 2025, your application will be INCOMPLETE and will not be considered.
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First Name
Last Name
Email for Recommender 1
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example@example.com
Name of Recommender 2
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First Name
Last Name
Email for Recommender 2
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example@example.com
37. Please verify that you are human
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38. 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.
39. 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.
40. Signature
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41. Today's Date
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Month
-
Day
Year
Submit
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