Junior Docent Program Online Application

Junior Volunteer Application

"*" indicates required fields

Step 1 of 3 - Parent/Guardian Permission

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Becoming a Junior Docent is an opportunity for teenagers to explore history, develop skills in leadership, time management, and public speaking while at the same time making a significant contribution to the community.

Selection is based upon application, teacher recommendation, parent or guardian permission, and an interview.

This application will start out with the parent/guardian permission form, then the student application, and finally the teacher recommendation form which may be completed online here or printed out to be filled out and returned later.

Parent/Guardian Permission Form

General Information

Junior Applicant's Name*

First Last

Please list main contact information of the Parent/Guardian.

Parent's/Guardian's Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Phone Type

Email (Optional)

Emergency Contact Information

We require at least one emergency contact that is not the Parent/Guardian of the junior applicant. You may add up to three if you so wish.

Name of Contact*

First Last

Phone*

Relationship to Applicant

Add Second Contact?*

Yes

Name of Contact*

First Last

Phone*

Relationship to Applicant

Add Third Contact?*

Yes

Name of Contact*

First Last

Phone*

Relationship to Applicant

Other Applicant Information

Does the Applicant have any allergies or any other medical or physical needs that our staff needs to be aware of?*

Yes

Please list all conditions that apply:*

May we have permission to use photographs of the applicant in our promotions?*

Yes

WIll the applicant have reliable transportation?*

Yes

Does the applicant have time in their schedule to dedicate to this program?*

If selected, the applicant would be coming to the museum for a minimum of six (6) hours each month and are expected to remain in the program for one (1) year.

Yes

Parent/Guardian Confirmation

I support the applicant's commitment to the Phelps Mansion Museum's Junior Docent Program. I am aware that he/she has assumed the responsibility of volunteering for the required time and I will be certain that he/she is present for the assignment or that the staff is informed of absences. I also agree to attend an interview/orientation session with the applicant. Parental/Guardian input and group support is encouraged by the Phelps Mansion Museum.

Do you consent to the above?*

I agree and will electronically sign and date

Date*

Month

Day

Year

Student Application

This form must be filled out by the applicant and will include general information and questions.

General Information

Name*

First Last

Phone*

Best number to reach you.

Email (Optional)

Currently Enrolled School*

Grade Level*

Please enter a number from 6 to 12.

Date of Birth*

Month

Day

Year

Questions

Will you have reliable transportation?*

Yes

Do you believe you have the time to dedicate the required time to the museum?*

Required time is at least six (6) hours per month for up to one (1) year.

Yes

Are you a part of any extracurricular activities at your current school?

Yes

What sort of extracurricular activities are you a part of? (Optional)

Why do you want to partake in the Junior Docent Program at the Phelps Mansion Museum? (Optional)

Electronically Sign and Date

Electronic Signature*

Check this box to sign this form electronically

Date*

Month

Day

Year

Teacher Recommendation Form

This form must be filled out by one of the teachers of the applicant concerning the teacher's personal recommendation of applicant to the Junior Docent Program.

This form is required for every student applicant. We appreciate your participation in this program.

Due to the unlikelihood of the applicant, parent, and teacher all being on the same computer, you may print out this form instead and submit the previous two. You can print out this form by clicking the button below. Please return this sheet to the Phelps Mansion Museum or email a copy at info@phelpsmansion.org.

Print Form

**After printing, please leave the rest of this page blank and click "Submit" at the bottom so we can get the info you already entered.**

Student's Name

First Last

Teacher's Name

First Last

Teacher's Phone

Teacher's Email (Optional)

Subject Taught/Relationship to Student (Optional)

How long have you known the Student? (Optional)

Please rate the student on various matters so that we might learn more about them.

Study Skills

How well does the student learn material? (I.e. Being able to understand museum policy and history.)

Above Average

Average

Below Average

Poor

Teamwork

Does this student work well with others?

Above Average

Average

Below Average

Poor

Dependability

Does this student show a reliable work ethic?

Above Average

Average

Below Average

Poor

Speaking Skills

Does this student show an aptitude for public speaking and other communication?

Above Average

Average

Below Average

Poor

What talents or skills do you think this Student has to offer to the Junior Docent Program?

Are there any talents or skills you think are important for the Student to learn from this program?

Are there any additional notes you have about the Student regarding the program?

Electronic Signature (Online Only)

If this form was completed online, please check the box to electronically sign

Date

Month

Day

Year

If printed and filled out, please return this form to the Phelps Mansion Museum at 191 Court Street, Binghamton, NY 13901. Or email us a copy at info@phelpsmansion.org.