1. WEST SENECA CENTRAL SCHOOLS
Summer Camp 2010
August 2, 3, 4, 5, and 9
~ SPONSORED BY ~
Academy of Information Technology
APPLICATIONS DUE TO YOUR COUNSELOR NO LATER THAN
FRIDAY, MAY 21, 2010
(Type or Print)
_____________________________________________________________________________________
(Last Name) (First) (School)
_____________________________________________________________________________________
(Counselor) (Grade)
_____________________________________________________________________________________
(Home Address) (Telephone Number)
1. Previous Work Experience/Volunteer Experience.
(Including yard work, babysitting/formal or informal) ___________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
2. List club memberships, sports and extra-curricular activities. ______________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
3. Do you own or have a computer available to you?  YES  NO
What experience do you have with computers?
(Briefly describe how you use it and software you are familiar with.)
_____________________________________________________________________________________
_____________________________________________________________________________________
(PLEASE COMPLETE THE OTHER SIDE OF THIS APPLICATION)

2. 4. How many days have you been absent this year?
 0-5  6-10  11-20  21+
If more than 5, briefly explain why? _________________________________________________
____________________________________________________________________________________
5. What is your overall grade point average? _____________________________________________
6. What foreign language(s) have you taken in school? (Indicate level) _______________________
_____________________________________________________________________________________
7. Why are you interested in being selected for this program? _______________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
8. In the area below, write a brief paragraph (six to ten sentences) describing yourself.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
9. List two teachers that you intend to use as references.
________________________________________ _____________________________________
I understand that if I am accepted into this Summer Camp Program, I will be committed to
completing the entire week’s agenda and to participating in all required activities.
_________________________________________
(Signature of Applicant) (Date)
I have read this application and information sheet and approve of my child’s participation in this
Summer Camp Program if he/she is selected.
_________________________________________
(Signature of Parent) (Date)