/ Staff/Volunteer Inquiry Form
VISIONS VCB Summer 2016
VISIONS/Services for the Blind and Visually Impaired operates a residential rehabilitation and training center, VCB, in Rockland County, New York, just 35 miles north of New York City. Each year, VCB serves a diverse population of over 600 people of all ages who are blind or visually impaired.
Fill out this form and fax to 212-219-4078 or email if you want:
·  a rewarding summer (No previous experience with people with disabilities is required, we train you.)
·  to make a difference in the lives of others and gain lifetime memories
·  a significant experience that stands out on your resume and could lead to a new career choice
Last Name / First Name / Middle Initial
Permanent Mailing Address / Apt # / City / State
ZIP / Email / Permanent Telephone
Current Telephone: / Cell Phone
Check all Positions for which you are applying (see job listings provided, Supervisors must be able to commit for the entire summer):
Supervisor
DH Mngr
Counselor / DH Staff
Parent Helper
Porter / Program Specialist
Driver
Other (______)
Type of applicant to VISIONS VCB: New Returning from summer of
VCB SUMMER 2016 SESSIONS (Check all sessions you are available):
Summer Weekend I : Water Skiing trip(OFFSITE)-Westchester Dinner Theater Group for Adults who are Blind – 7/14/16 to 7/17/16.
Summer Weekend II: Deaf Blind Coalition (DBC)- up to age 26 who are deaf blind - 7/21/16 to 7/24/16.
Summer Session 3: “Better Choices, Better Health”- 7/27 to 8/8 Adults who are blind & their family
Summer Session 4: “ First Steps”- 8/12/16 to 8/19/16 Babies and toddlers up to age 5 who are blind and children who are blind and multi-disabled up to age 21 with their parents.
Summer Session 5: “Rehab & Rec” for Blind Children with Families, “Tween Pre-Voc”- 8/20/16 to 8/27/16 Children who are blind (entering grades 1-9 & ages 6-14), with their parents.
VCB is a residential center and staff for the most part is required to reside on site. Are you willing to live on the facility grounds? Yes No If no, Please explain: (off-site residence may be considered for some positions):
Please indicate any current certifications or credentials you have that would be helpful in the VCB setting (attach documentation verifying credentials/certification). Check all that apply:
First Aid CPR Lifeguard LMSW TVI COMS EI CVRT OT/PT/OTA
How did you find out about VISIONS VCB?
Career Fair Email Career Development Office Friend Other:
What do you hope to gain from your experience at VISIONS VCB? (Add additional pages if needed.)

Attention: Khaled Musa Send via fax (212) 219-4078 or email to: