CONTACT INFORMATION
Last Name First Name Middle Initial

Home Phone Cell Phone

Street Address City State Zip

Email Date of Birth

Best Method of Contact Select Email Cell Phone Home Phone If Phone, Best Time to Call Select Morning Afternoon Evening

LEGAL INFORMATION
Have you ever plead guilty, "no contest," been found guilty, or been convicted of (a) any felony or (b) any misdemeanor involving violence, sexual misconduct, or posession, transport, or sale of illegal drugs? Note: Existence of convictions will not necessarily disqualify any application from participation. If a guilty plea of conviction has been expunged from your criminal record, you do not have to disclose and may answer "No." Select No Yes
If you answered, "Yes," please explain in the space below giving the date, location, and charge.

QUESTIONS
Have you been involved with Iowa HOBY, HOBY International, or any other state affiliates of HOBY in the past? If yes, please list your title(s), date(s), and location(s) of your previous participation with HOBY. If no, how did you hear about us and why do you want to participate in this year's seminar?


Do you have any prior experience working with high school aged individuals? If yes, please explain.

Do you have suggestions for other people who should be considered for the Senior Staff? If yes, please list the name and contact information of the individual(s) below.

RETURNING SENIOR STAFF
What suggestions do you have for this year's seminar? This is an open forum, so please feel free to speak candidly. We are always looking for ways to improve the seminar each year and want to make everyone's experience a positive one!