A&M Give Us Room!
Host for WHOOPIN’ WEEKEND 2011!
This opportunity is open for all ON CAMPUS Aggies to host high school seniors interested in becoming Aggies.
Whoopin’ Weekendƒ is a conference put on by Aggie Recruitment Committee that provides a chance for these students to
see what goes on at A&M and to experience a snapshot of Aggie Life.
As a host your responsibilities are to (1) watch an online hosting informational video and complete an accompanying quiz
online, (2) provide a place for up to two participants to stay during the conference in your on campus dorm, (3) be in your
dorm room when the participants are dropped off at night (around 11:20PM on Friday and around 10:15PM on Saturday,
(4) escort the participants to the designated meeting spot in the mornings at 8:30AM, and (5) share your Aggie stories
with future members of the Aggie family!
WHOOPIN’ WEEKEND will be held on February 18th-20th
Please be sure that you and your roommate read and agree to the following guidelines before signing and returning this
application. Also by signing this application, you give Student Government the right to verify with university records that
you have not previously had any behavioral infractions with Texas A&M University.
The information provided below will be used to screen for criminal convictions. Your employment or volunteer
participation in any Texas A&M University program is contingent upon the satisfactory completion of a background
screening. Individuals who have been convicted of a sexual offense are not eligible to serve in an employment or
volunteer capacity for TAMU affiliated camps or enrichment programs in positions responsible for the direct or indirect
supervision of campers or program participants, or which may allow for unsupervised access to, or interaction with,
campers or program participants.
Visiting participants are not allowed off campus for any reason! No participant, committee member, or host will be
allowed to consume alcohol, drugs, or tobacco products at any time during the conference. They will be required to attend
all WHOOPIN’ WEEKEND activities, therefore it is important that you drop them off and pick them up at the designated
times. A schedule of the activities and more specific rules will be available online.
I will be contacting you about Host Informationals which will be held online this year for your convenience. A
video of the Host Informational will be posted online with an accompanying quiz and electronic signature.
If you have any questions about hosting or problems with the online quiz or electronic signature contact Paul Pesek at
paulpesek@tamu.edu or by phone at 361-816-2442.
Please keep this top page for your reference. Only return the accompanying
two pages. Host Apps are due February 8th.
Office Phone : (979) 458-2637
Office Fax : (979) 847-8854
archousing@gmail.com
The information on this form, together with any attachments, is the property of Texas A&M University. State law requires that you be
informed of the following: (1) you are entitled to request to be informed about the information about yourself collected by use of this
form (with exceptions as provided by law); (2) you are entitled to receive and review that information; (3) you are entitled to have the
information corrected at no charge to you.
WHOOPIN’ WEEKEND 2011 Host Background Check
Form
Roommate 1:
Name _______________________________________________________________________________
Last
First
Middle
Other names you have used (including maiden name) __________________________________________
Current Address: _______________________________________________________________
Street Address
City
State
Zip
If you have lived at this address for less than two years, provide your previous address (es):
_____________________________________________________________________
Conviction Record
Have you ever been convicted of a violation of any local, State, or Federal law other than minor traffic violations? (This includes a
plea of guilty or no contest.)
YES
NO
If yes, Date of conviction: __________________ (MM/DD/YY)
If yes, was the offense a felony or misdemeanor? ____________________
Describe the offense: (If there are multiple convictions or if additional space is required, please include attachments.)
________________________________________________________________________
I, the undersigned, confirm that the statements made by me on this form are true, correct, and complete to the best of my knowledge and belief, and
are made in good faith. I understand that any false statements made herein will void my application for the Aggie Recruitment Committee. I
authorize the operators of the above referenced organization, and or the Texas A&M University Employment office to check my personal
information against records maintained on the Texas Department of Public Safety Crime Records Service, Sex Offender Database or other similar
State or Federal criminal records. I hereby authorize any law enforcement agency to furnish to Texas A&M University, or its agent, my criminal
conviction record for a misdemeanor or felony offense. I do hereby release all agents, servants, and employees of Texas A&M University, the person
in charge of such law enforcement agency or department, and all members of such law enforcement agency or department from all liability resulting
from the furnishing of this information to Texas A&M University.
Signature _________________________________________________________Date _____________________
Roommate 2:
Name _______________________________________________________________________________
Last
First
Middle
Other names you have used (including maiden name) __________________________________________
Current Address: _______________________________________________________________
Street Address
City
State
Zip
If you have lived at this address for less than two years, provide your previous address (es):
_____________________________________________________________________
Conviction Record
Have you ever been convicted of a violation of any local, State, or Federal law other than minor traffic violations? (This includes a
plea of guilty or no contest.)
YES
NO
If yes, Date of conviction: __________________ (MM/DD/YY)
If yes, was the offense a felony or misdemeanor? ____________________
Describe the offense: (If there are multiple convictions or if additional space is required, please include attachments.)
________________________________________________________________________
I, the undersigned, confirm that the statements made by me on this form are true, correct, and complete to the best of my knowledge and belief, and
are made in good faith. I understand that any false statements made herein will void my application for the Aggie Recruitment Committee. I
authorize the operators of the above referenced organization, and or the Texas A&M University Employment office to check my personal
information against records maintained on the Texas Department of Public Safety Crime Records Service, Sex Offender Database or other similar
State or Federal criminal records. I hereby authorize any law enforcement agency to furnish to Texas A&M University, or its agent, my criminal
conviction record for a misdemeanor or felony offense. I do hereby release all agents, servants, and employees of Texas A&M University, the person
in charge of such law enforcement agency or department, and all members of such law enforcement agency or department from all liability resulting
from the furnishing of this information to Texas A&M University.
Signature _________________________________________________________Date _____________________
Office Use Only: Date screen concluded:____________ Operator:____________________________
□ Screen conducted: __No DPS Criminal History __Not Found in Registered Sex Offenders Database
□ Screen conducted: __Criminal History Found __Registered in Sex Offenders Database
WHOOPIN’ WEEKEND 2011
Host Information
(Please write as clearly as possible!!)
Roommate 1:
Name ________________________________________________
Last
First
Email (one you check) _____________________________________
Cell Phone Number _________________________
Are you a member of ARC? Y N
Roommate 2:
Name ________________________________________________
Last
First
Email (one you check) _____________________________________
Cell Phone Number _________________________
Are you a member of ARC? Y N
Gender:
Male
Female
Location:
Northside
Southside
Corps Members: Y
N
Dorm Name _____________ Room Number _________________
Do you have a phone plugged into the jack your room? ______
If yes, what is the number? 847-________
Would you be interested in hosting for Whoopin’ Weekend in the Spring? Y
How/From whom did you hear about hosting for WHOOPIN’ WEEKEND?
______________________________
N
____________________________________________________________________________
Please remember to check the ARC website for the dates and times for mandatory host
informationals. Any person wishing me to sign off on community service hours for an
organization or for some other reason can reach me at 361-816-2442 to arrange a meeting.
Please return completed forms ASAP to the lockbox marked “Aggie Recruitment Committee”
located on the first floor of Koldus just inside the doors to Student Activities (to the right) next to
the front desk.