Dear Applicant, Sincerely, Amy R. Blake Program Supervisor

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1 River Plaza 9 West Broad Street Stamford, CT (866) toll free Fax (203) Dear Applicant, The Summer Institute for the Gifted (SIG) has been a leading provider of gifted educational opportunities since 1984 and is recognized within the gifted and talented community for providing the highest quality programs available to meet the needs of academically advanced students. SIG combines academic, cultural, and recreational programming, which is designed to provide an intellectually stimulating, warm, and enjoyable three week experience for participating students. Our summer programs now serve over 2,000 gifted students and are located on thirteen prestigious campuses throughout the continental United States. In order to provide our students with the high-quality learning experiences, which they have come to expect from SIG, it is imperative that we hire well-trained and dedicated employees. As a SIG employee, you would have the opportunity to contribute to the creation of a supportive, structured, and safe community that caters to the social and emotional needs of our gifted students. If you are interested in applying for a position with the Summer Institute for the Gifted, please fill out the appropriate application form. Please do not forget to attach your resume. Once we have received your completed application, you will be contacted if your qualifications meet our needs. If you have any questions concerning the application process, please do not hesitate to contact Amy Blake at ablake@giftedstudy.com. Thank you for considering the Summer Institute for the Gifted in your search for summer employment. Sincerely, Amy R. Blake Program Supervisor

2 Nurse Job Description The Responsibilities of the Nurse include: Residential Program: The infirmary must be staffed by a nurse 24 hours a day, including Saturdays, while the program is in session. The nurse reports to the Site Director. Day Program: The infirmary must be staffed by a nurse from 8:30 am 4:00 pm, while the program is in session. The nurse reports to the Day Program Director. Qualifications: Enjoys working with young people in grades K 11. Registered Nurse (RN) Degree State Registered Professional Nursing License. American Red Cross Standard First Aid Certification or equivalent. CPR Certification. Liability Insurance Certificate coverage of at least $1,000, Summer Institute for the Gifted must be listed as Additional Insured on the certificate. Assess and care for ill and injured students and refer students to off-campus services as needed. Administer medications and treatments ordered by a student s personal or covering physician. Maintain accurate records in the nursing log, supplementary notes, medication sheets, accident forms, and Workman s Compensation forms. Refer a student to the Site Director for evaluation by mental health professionals after conferring with parents, if he/she threatens to harm him/herself or others, shows signs of drug abuse, or appears to be emotionally unstable. Work cooperatively with parents, physicians, Deans, Directors, and staff to keep everyone aware of emerging student health issues and problems. Identify communicable diseases and isolate infected students as needed until arrangements are made for their departure. Set up and maintain the health care rooms. Check in students at registration to collect any medications they have brought, and ensure that their health forms are current and complete. Follow the policies and procedures as established in the SIG Policies and Procedures book, as well as those of the overall SIG program. Keep the Site Director informed of all serious medical problems, telephone conversations with parents, and accidents involving the SIG students or staff. Attend and assist at orientation and registration during the first weekend of the program. Prior to the program, review student medical forms and produce a list of students with special medical needs for SIG staff. (Stipend of $ to be paid) (1 st week nurses only) Check the inventory of medical supplies at the beginning and end of the SIG program. At the end of the program, discard supplies that will be out of date by next summer, and produce a) an inventory list of medical supplies and b) a list of needed medical supplies for next summer.

3 Nurse Application We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, marital or veteran status, or any other legally protected status. (PLEASE PRINT) How did you learn about SIG? (Please be specific) Last Name First Name Social Security Number Address Number Street City State Zip Code Telephone (Home) Telephone (Cell) Address Best time to contact you at home is:.. : By checking this box, I agree that I will be 18 or older by June 1 of the program year.. Yes No Have you ever filed an application with us before?.. Yes No If Yes, give date Have you ever been employed with us before?... Yes No If Yes, give date Are you currently employed?.. Yes No May we contact your current employer?. Yes No Have you ever been convicted of a criminal offense? Yes No If Yes, please explain Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status. Yes No Proof of citizenship or immigration status will be required upon employment WE ARE AN EQUAL OPPORTUNITY EMPLOYER

4 EDUCATION Name of School Course of Study Years Completed Diploma Degree Undergraduate College Graduate Professional Other (Specify) Describe any specialized training, apprenticeship, skills and extra-curricular activities. EMPLOYMENT EXPERIENCE 1. Employer Address Dates Employed From To Work Performed Telephone Number(s) Job Title Reason for Leaving 2. Employer Address Dates Employed From To Work Performed Telephone Number(s) Job Title Reason for Leaving

5 3. Employer Address Dates Employed From To Work Performed Telephone Number(s) Job Title Reason for Leaving If you need additional space, please continue on a separate sheet of paper List professional, trade, business or civic activities and offices held. ADDITIONAL INFORMATION Summarize special job-related skills and qualifications acquired from employment or other experience REFERENCES 1. ( ) (Name) (Phone #) (Address) ( Address) 2. ( ) (Name) (Phone #) (Address) ( Address) PLEASE NOTE: REFERENCES WILL BE CONTACTED.

6 CAMPUS SELECTION Please indicate your campus preference by placing a check mark ( ) on the lines provided. Please indicate your availability by circling the week number(s). Residential Program (the infirmary must be staffed by a nurse 24 hours a day) Weeks you are available Vassar College I Poughkeepsie, NY June 21 July Bryn Mawr College Bryn Mawr, PA June 22 July University of California I Berkeley, CA June 22 July University of Michigan Ann Arbor, MI June 22 July Emory University Atlanta, GA June 29 July Vassar College II Poughkeepsie, NY July 13 August University of Texas Austin, TX July 13 August University of California II Berkeley, CA July 20 August Princeton University Princeton, NJ July 20 August Amherst College Amherst, MA July 20 August University of California Los Angeles, CA July 27 August Day Program (the infirmary must be staffed by a nurse from 8:30 am 4:00 pm) Moorestown Friends Moorestown, NJ June 23 July Manhattanville College Purchase, NY June 30 July Fairfield University Fairfield, CT July 14 August Stuart Country Day School Princeton, NJ July 21 August ADDITIONAL QUALIFICATIONS Please provide the date of your CPR Certification and the name of the university/organization where you obtained this certification. Please list other licenses, certificates, or registrations held in connection with your profession and the states in which they are held.

7 QUESTIONS Please state your philosophy of nursing practice as it relates to dealing with students. Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING. Are you capable of performing in a reasonable manner, the activities involved in the job or occupation for which you have applied. YES NO I certify that I will be 18 or older by June 1 of the program year and that answers given herein are true and complete. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an at will nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this at will employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. Signature of Applicant Date PLEASE ATTACH YOUR RESUME TO THIS APPLICATION AND FORWARD TO: ATTN: SIG Staffing Summer Institute for the Gifted/AIFS River Plaza 9 West Broad Street Stamford, CT,