Adult Staff Online Registration

Adult Staff Application

Please complete this form and submit by Friday, March 27th to be considered for adult staff.
Potential youth staff and intern staff can only submit an application by mail.

* Indicates required field

Name *

First

Last

Address *

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Line 2

City

State

Zip Code

Country

Email *

Gender *

T-Shirt Size *

Employer *

Job Title *

Employer Address *

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Line 2

City

State

Zip Code

Country

Cell Phone *

Work Phone *

What experience do you have working with high school students? *

What experience do you having working with TI or other drug free programs? *

Please select the roles you would be willing to do: *

Family Group Co-Facilitator- Must be 21 years old Residence Hall & Security Nurse Administrative Staff

If you wish to co-facilitate a family group, briefly details you facilitation experience *

Are you a licensed social worker or counselor willing to serve on Care Team? *

Yes No

Dietary Considerations and Special Needs: *

I understand that as a member of the Ohio TI Adult Staff I agree to attend the entire Ohio TI Conference, participate in all scheduled activiites including Staff Training, and follow all rules deemed necessary for the success of the 2013 Ohio TI Conference. I acknowledge that I meet the qualifications for Adult Staff. I also understand that I will be serving as a role model and must adhere to a high standard of conduct. TI is the an abstainence based organization. I agree to remain tobacco, alcohol, and other drug free during the TI training.

Choose Any *

I have read the above and agree to follow these expectations I understand that I must submit a background check prior to the conference

Submit