Staff Application
Project COMMON BOND 2015
July 25 – August 3, 2015
Bryn Mawr, PA
Staff Application
Group Leaders’ most important role is to ensure that participants are safe, feel comfortable in the
environment, enjoy their time at PCB, and report to all activities and meals on time. Group Leaders
need to have high energy, enthusiasm, compassion, and commitment, and must be 21+ years old.
Additionally, each Group Leader will be assigned a small group of participants to engage with on a more
direct level. Speaking a second language is beneficial but not required.
Chaperones are generally representatives from international non-governmental organizations. These
organizations have participated in the identification and screening of participants, eligible to attend
Project COMMON BOND. The organizations are generally agencies which provide support services to
individuals impacted by the violent extremist/terrorist acts in their country. Chaperones need not be
mental health professionals, however many have come from the fields of mental health, psychology,
education, peace activism, government, advocacy, child welfare. Many have been personally affected
by war and violent extremism, and have an extraordinary empathy for those similarly affected. In that
capacity, they act as mentors. They inspire and motivate.
Please note which staff role you are applying for.
Group Leader
First Name:
Age at
PCB:
Country Chaperone
Middle Initial:
Date of Birth: (mm/dd/yyyy)
Street Address:
E-Mail Address:
City:
Last Name:
Gender:
State /
Region:
Home Phone Number:
T-Shirt Size (S, M, L, XL,
2XL):
Zip Code:
Country:
Cell Phone Number:
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Passport Number:
Social Security
Number:
- –
Passport Expiration
Date:
Passport City of Origin:
Insurance Information (Please attach a copy of card)
Company Name:
Subscriber:
ID #:
Additional Information:
University:
Education Level
BA/BS
MA/MS
PhD
Religion:
First Language:
Course of Study:
Additional Languages:
Additional Language Proficiency Level (beginner, intermediate,
fluent)
Speaking:
Reading:
Writing:
How did you hear about Project COMMON BOND?
Please list one professional reference (employer, professor, coach etc.)
Name:
Contact Number:
E-Mail:
Have you experienced the loss of an immediate family member (parent, grandparent, sibling)
in your own life? Yes
No
Please Explain (Optional)
Health Information:
Dietary Restrictions:
Allergies:
Disabilities:
2
Emergency Contact Info:
Name:
Home Phone Number:
Relationship:
Cell Phone Number:
Have you ever been convicted of a felony or accused or convicted of a crime or maltreatment
against a child?
Yes
No
If yes, explain:
Program Information:
All staff members may have opportunities to assist in elective classes. Please rank your choices
of interest in reference to the following Project Common Bond workshops, from 1- 5, with 1
being your first choice, and 5 being your last.
Sports
Dance/Movement
Music
Drama
Art
Peace.we.*
* Peace.we is an elective which creates space for a self- selected group of participants who are
motivated and empowered to be youth peace builders, developing and implementing their own
creative, innovative and actionable peace building projects. The Peace.we program aims to
empower youth and to provide them with the tools and connections to capitalize on their own
skills and expertise. This elective is for participants looking to take a serious step towards peace
building.
Do you play a musical instrument? If so, what instrument:
*If possible, please bring your instrument to the program.
Additional Items to Include

Please Attach a Resume / CV
Application Deadline: April 24th 2014
Please return electronically to: Deirdre@tuesdayschildren.org
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If you have any questions, please contact Program Coordinator, Deirdre Dolan at:
Deirdre@tuesdayschildren.org.
Signature:
Date:
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