Bright Lights: Classroom Assistants

Please Note: This application will take approximately 15-20 minutes to complete. Please have two job references, their phone numbers, and your emergency phone number handy.

There are two sections: All applicants fill out Section 1. Only applicants 19 and over by June 1, 2008 need to fill out Sections 1 and 2.

* = Required.

Section 1

Personal Information

* Name:

(first, last)

* Address:

* City, State, Zip:

* Date of Birth:

Enter the following phone numbers, or type "none" if not applicable.

* Home Phone:

(format xxx-xxx-xxxx)

* Summer or Cell Phone:

(format xxx-xxx-xxxx)

* E-Mail:

* T-Shirt Size:

What size of Bright Lights t-shirt would you like?

Teacher Request:

Did a teacher ask you to be his/her classroom assistant?
If yes, teacher's name:

Emergency Contact

* Name:

(first, last)

* Relationship:

* Phone:

Personal Information Continued

* Gender:

* Racial/Ethnic Background:

* Classification:

School Attending:

Current Grade:
(High School Students)

Your answers to the following six questions are for informational purposes only.

Are you interested in a teaching career?	Yes No
Have you ever considered teaching internationally?	Yes No
Are you an education major?	Yes No
Are you a scout or do you work for a scouting organization?	Yes No
Do you work with 4-H?	Yes No
Do you work with a Community Learning Center?	Yes No
List other organizations you work with or are a member.
Former BL Student?	Yes No
Former BL Assistant?	Yes No
For What Class?

Select Dates & Times Available
Providing more choices of dates and times gives us more flexibility of placement.

*Program Dates & Times Available AM = 8:45am - 12:15pm \| PM = 12:45pm - 4:15pm
Classroom or office assistance			For office work or data input only
Week 1 June 9-13	Week 2 June 23-27	Week 3 July 7-11	July 14-18	July 21-25
AM PM	AM PM	AM PM	AM PM	AM PM

* Orientation You must attend one of these sessions.
Sat. May 31 9:30am-11:00am	Tue. June 3 4:00pm-5:30pm

International Program:
	June 23-27 - AM	Assist with Japanese middle school students at Lux Middle School, near 84th and Van Dorn Streets. Must be grade 11 or older.
Please explain your interest in the International Program:

Select Areas of Interest
Providing more choices of interests gives us more flexibility of placement.

Art
	Art/General
	Art/Clay
	Art/Drawing
	Architecture
	Cooking
	Crafts
	Painting

Cultures & Diversity
	Foreign Language/French
	Japanese Culture

History/Law
	Pioneer Times
	Ancient Egypt
	Law

Language Arts
	Literature/General
	Literature/American Girl
	Literature/Harry Potter
	Literature/Laura Ingalls Wilder
	Writing
	Theater/Drama
	Spanish

Math
	Chess
	Origami
	General Math (elementary level)

Science
	Life Sciences (biology, microscopes, crime scene investigations)
	Animal/Insects
	Physical Sciences

Technology
	Computers/CAD/Industrial Technology
	Computers/iMovie
	Computers/Lego Robotics
	Small Engines
	Video
	Garage Band
	Logo Programming Language
	Photography
	Animation
	Woodworking

Others
	Baseball History
	Music Performance
	Fishing
	Knitting
	Manners
	Outdoor Classes

I would be interested in...

	Office Work
	Data Input

Photographers Needed I am a high school journalism/yearbook photographer and would be interested in taking photos of Bright Lights over a one-week period.	Yes No
Can you assist with before class care? (7:30 a.m. - 9:00 a.m.)	Yes No
Lunch hour supervision? ($15 stipend) (12:00 p.m. - 1:00 p.m.)	Yes No
Assist in more than one class?	Yes No
Assist at main program site only? *	Yes No
* Seventy-five percent of classes are located at Randolph Elementary School. The balance of the classes are held in community site classrooms, such as UNL, a scrapbooking store or Southeast High School. Assistants must provide their own transportation to sites.
Would you like to help on moving day?
Tue., June 3 -- 9:00 a.m. - 12:00 p.m.	Yes No
Tue., July 15 -- 8:00 a.m. - 11:00 a.m.	Yes No

In the box below, briefly include any additional information that will assist in placing you, such as scheduling issues or a strong interest in a particular subject area or grade level. Indicate if you would also be interested in helping with a book fair which may be held at the main program site.

References

Please provide two references (teachers, employers, etc...) whom we may contact regarding your conduct and character. This information is necessary for us to give your application full consideration.

Reference 1

* Name:

(first, last)

* Address:

* City, State, Zip:

* Phone:

* Title / Relationship:

Reference 2

* Name:

(first, last)

* Address:

* City, State, Zip:

* Phone:

* Title / Relationship:

Please list any additional volunteer and/or work experience:
(Please include supervisor/employer's name, address, and phone, and position/responsibilities.)


		BRIGHT LIGHTS - Summer Learning Adventures 5561 South 48th Street, Suite 220 \| Lincoln, NE 68516 (402) 420-1115 \| (402) 420-5954 fax \| info@brightlights.org