STEMS Up! Science, Technology, Engineering and Mathematics Camps at Southern Polytechnic State University for Middle and High School Students

STEMS Up!
Southern Polytechnic
State University
1100 South Marietta
Parkway
Marietta, GA
30060-2896
678.915.3163
678.915.7240
678.915.7490 fax

Apply in one of three ways:

Pick up application in person
Download application and fax or mail back
Online using the form below

Online STEMS Up 2008 Staff Application
Please fill out completely. All fields are required.

Personal Data

Position Desired:
Choose all that apply.

Director (Resume required. See Contact link for address and contact name.)
Teacher
Counselor

Group you prefer:
Choose all that apply.

7th - 9th
Mentor Program
10th - 12th College Life

First Name:

Middle Name:

Last Name:

Mailing Address:

City:

State:

Zip:

Daytime telephone:

Evening telephone:

E-mail:

Please list availability. Check all that apply. *Please note those with flexible availability will be given priority.			Days Available to Work
Camps Available to Work		Times of Day Available to Work	M	T	W	TR	F
	June 2-6 & June 9-13
	June 16 - 20 & June 23-27
	July 7-11 & July 14-18
	July21-25 & July 28-Aug 1

Education

School:
Major:
Current year:	Freshman Sophomore Junior Senior Graduate
Are you currently a certified lifeguard?	Yes No
Do you have current CPR/First Aid certification?	Yes No
Have you ever been arrested and/or convicted of any crime?	No Yes, please explain.

Past Experience

Work Experience, Last Three Employers, Most Recent First:

Employer #1
Company Name:
Supervisor's Name:
Job Function or Title:
Mailing Address:
City:
State:
Zip:
Telephone:
E-mail:
Starting Date:
Ending Date:

Employer #2
Company Name:
Supervisor's Name:
Job Function or Title:
Mailing Address:
City:
State:
Zip:
Telephone:
E-mail:
Starting Date:
Ending Date:

Employer #3
Company Name:
Supervisor's Name:
Job Function or Title:
Mailing Address:
City:
State:
Zip:
Telephone:
E-mail:
Starting Date:
Ending Date:

References:

Please list three references. All fields are required.

Reference #1
Last Name:
First Name:
Mailing Address:
City:
State:
Zip:
Telephone:
Relationship:

Reference #2
Last Name:
First Name:
Mailing Address:
City:
State:
Zip:
Telephone:
Relationship:

Reference #3
Last Name:
First Name:
Mailing Address:
City:
State:
Zip:
Telephone:
Relationship:

Why you would like to work with SPSU's STEMS Up program...

Why are you interested in working with the adolescent and young adult programs?

What different qualities do you possess to make the camp activities be unique from the traditional academic setting? What unique quality do you possess that will make you a good addition to our team?

TEACHERS ONLY:

Current Certifications:
Teaching Experience (Years):
Grade level currently teaching:
Subjects Taught:

Online STEMS Up 2008 Staff Application Please fill out completely. All fields are required.