Bright Lights: Classroom Assistants

2010 Classroom Assistant Application

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, 2010 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 14-18	Week 2 June 28-July 2	Week 3 July 12-16	July 19-23	July 26-30
AM PM	AM PM	AM PM	AM PM	AM PM

* Orientation You must attend one of these sessions.
Sat. June 5 9:30am-11:00am	Tue. June 8 4:00pm-5:30pm

International Program:
	June 28-July 2 - 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 your skill areas and expertise or strong interest
Providing more choices of interests gives us more flexibility of placement.

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

Cultures & Diversity
	Foreign Language/French
	Japanese Culture
	Australia

History/Law
	Ancient Egypt
	Law
	Pioneer Times
	Time Travel

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

Math
	Chess
	General Math (elementary level)
	Origami

Science
	Animal/Insects
	Chemistry
	Crime Scene Investigation
	Electricity
	Medical
	Natural Disasters
	Ocean
	Rain Forest
	Solar System

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

Others
	Baseball History
	Cake Decorating
	Fencing
	Fishing
	Fitness
	Guitar
	Jewelry
	Knitting Knowledge
	Magic Knowledge
	Manners
	Music
	Outdoor Classes
	Woodworking

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?
Mon. June 7 -- 9:00 a.m. - 12:00 p.m.	Yes No
Mon. July 19 -- 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.

* Do you have any health concerns to share with us? Yes No

If yes, please describe.

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.)

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