______________________________________________________________________________________________________________________

AUGUST 2017 GRADE SCHOOL

Are you a member of MOCA? ___Y ___N

Please explain any employment or experiences working with children. Please
include age groups of children.

Do you have any volunteer experience? __Y __N If yes, please explain.

Please share why you would like to become a Teen Teacher.

What are your special interests and talents you could share with our art
campers?

REFERENCES
Please provide the names, addresses, and phone numbers of two references.
This does not include family members.

REFERENCE #1 NAME

HOME ADDRESS

CITY ZIP

HOME PHONE BUSINESS PHONE

MOBILE PHONE EMAIL

REFERENCES (CONTINUED)

__Session 1 June 5-June 9

__Session 2 June 12-June 16
__Session 3 June 19-June 23
__Session 4 June 26- July 2
__Session 5 July 10- July 14
__Session 6 July 17- July 21
__Session 7 July 24- July 28
__Session 8 July 31- August 4
__Session 9 August 7- August 11

A MANDATORY Teen Teacher orientation will be held before Art Camp. You will be
notified by email of the date and time. Please remember to respond that you will
attend.

QUESTIONS? Please contact Stephanie Jackson, Outreach and Volunteer Coordinator.

904-620-3212; Stephanie.jackson@unf.edu.

Thank you for your interest and involvement with MOCA Jacksonville.

Please return to Stephanie Jackson, Outreach and Volunteer Coordinator.

Stephanie.jackson@unf.edu
Fax: 904-366-6901