STARR January 25th and 27th, 2025: Staff Application

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This session of STARR will take place January 25th and January 27th, 2025 at West Market Street United Methodist Church in Greensboro.

If you need assistance completing this application, contact Kelly Dawson at kdawson@nccjtriad.org or 336-272-0359 x 210.

STARR Counselors must have previously attended either STARR or Anytown as a participant. Throughout the STARR program, counselors are expected to be actively engaged by working well with other staff members, contributing positively to group morale, leading small discussion groups, and supporting programs. GCS students receive 16 service-learning hours for serving as a STARR counselor.

STARR Adult Advisors must be at least 21 years of age. Throughout the STARR program, advisors are expected to be actively engaged by working well with other staff members, contributing positively to group morale, leading small discussion groups, and supporting programs. (Depending on staffing needs, applicants under 25 years of age may be asked to serve as STARR Counselors.)

Logistical Volunteers assist with tasks like handing out meals, setup/cleanup, check-in, and organizing materials, but will not be assigned to lead a student discussion group.

STARR Staff

I am applying to be a:

CounselorAdult AdvisorLogistical Volunteer

Full Name

First Name

Middle Name

Last Name

Suffix

What do you like to be called?

Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Contact Info

Email

Area Code

Phone Number

Employment Info

This information will not affect your application for STARR staff. We just want to know more about you!

If you selected "Current student" above, please complete the following information:

School

Degree pursuing

Expected graduation date

If you selected something other than "Current student" above, please complete the following information:

Place of employment or place retired from

Position

References

Please provide the name, email address and phone number of a reference that we may contact as part of the selection process.

Reference First Name

Reference Last Name

Reference Area Code

Reference Phone Number

Reference Email

Relationship

Ex: Teacher, Supervisor, Faith Leader

Application Questions

Why do you want to serve on STARR staff?

What special skills or knowledge would you bring to the STARR program?

How did you hear about STARR? If someone referred you, please list their name.

Have you participated in other NCCJ programs? If so, please list:

Commitment

You understand that if chosen as staff for STARR, you must attend ALL days of STARR. If you cannot commit to the full session, please do not submit your application.

(Depending on our staffing needs, we may be able to make exceptions to this rule on a case-by-case basis. Please contact Kelly Dawson at kdawson@nccjtriad.org or 336-272-0359 x 210 to discuss your individual situation.)

Please initial here to indicate that you can attend the full session of STARR.

Disclosure

By signing below, you consent to a criminal background check(s). This information is kept confidential and only viewed by NCCJ Staff.

Legal Name

Social Security Number

Driver's License or State ID Number. List state of issue if not from North Carolina.

Applicant Signature

Date

Parent/Guardian Signature (if under 18)

Date

As part of the application process, STARR Advisor applicants may be contacted to schedule an interview with a member of the NCCJ Program Staff.

Parent/Guardian Info (for applicants under 18 years of age)

If you are 18 years of age or older you may skip this page.

Parent/Guardian #1

First Name

Last Name

Relationship to the applicant

Parent/Guardian Email

Area Code

Phone Number

Parent/Guardian #2

If you are 18 years of age or older you may skip this page.

First Name

Last Name

Relationship to the applicant

Parent/Guardian Email

Area Code

Phone Number

Health History and Medical Release

Emergency Contact Information

(If you are under 18, we will contact the parent/guardian information you provided on the previous page.)

First Name

Last Name

Relationship

Area Code and Phone Number

Secondary Area Code and Phone Number

Health History

Do you have any physical limitations that may restrict participation in program activities? If so please provide details:

Do you experience sensory overload/sensitivity? If so, please list how this presents and steps we can take to help you manage:

Are you currently taking any medications that we should be aware of in the event of a medical emergency? If so, please list:

Do you have any medical conditions that we need to be aware of? If so, please list:

Is there anything else you want us to know?

Medical Release

The health history is correct and complete as far as I know. I understand and agree to abide by the restrictions placed on my activities during this program. I agree not to infringe on the safety of or knowingly cause bodily harm to the others in attendance at STARR. I also understand that North Carolina for Community and Justice (NCCJ), its officers, board members, volunteers, agents, employees and licensees cannot be held liable for any health complications or problems that resulted from or were caused by my negligent regard for my own health and safety.

Signature

Date

Parent/Guardian Signature (if under 18)

Date

Photo Release

I understand that I, alone or with participants, and/or NCCJ staff, volunteers or representatives, may be interviewed, photographed, recorded on film, audio tape, video, or other visual and sound computerized, telephonic, voice-mail or tape media ("photographs and/or sound/image recordings") and/or may provide written or oral statements to NCCJ and/or others approved by NCCJ.

I hereby consent to the foregoing and grant permission, without reservation, to NCCJ and/or those approved by NCCJ to generate, prepare, advertise, describe, and/or publicize NCCJ and its work, good will, public education and/or fundraising activities, disseminate, otherwise use and comment upon the photographs and/or sound/image recordings as they may determine, without review by me or my child/the child in my care and without financial or other obligation of any nature to me or my child/the child in my care. I consent that my child/the child in my care may be identified by name, age, race, school of attendance, city of residence, or program of participation as these companies and/or those approved by these companies may determine. Uses may include, but are not limited to, promotional videos, fundraising appeals, website content, and news coverage.

I release NCCJ, its officers, Board of Directors, volunteers, agents, employees and licensees from all claims that I or my child/the child in my care may have, or might have, for any cause of action arising out of the taking and/or use of the photographs and/or sound/image recordings as set forth herein. This consent and release shall continue in effect, without a limitation of time.

Please check the box below if you DO NOT want your photographs and/or image/sound recording used.

Signature

Date

Parent/Guardian Signature (if under 18)

Date

Bullying Policy

At North Carolina for Community and Justice (NCCJ), we have a firm policy against all types of bullying. Everyone in the program is expected to treat each other with respect. This includes students, volunteers, and NCCJ staff members. Our STARR staff has been trained to recognize all incidents of bullying and take them seriously. We promote respectful communication between staff and delegates and work together as a team to ensure that each delegates has a wonderful and safe experience at STARR.

What is bullying?

Bullying is aggressive behavior that is intentional, is repeated over time, and involves an imbalance of power or strength. Bullying can take on various forms, including:

Physical Bullying- when one person engages in physical force against another person, such as hitting, punching, pushing, kicking, pinching, or restraining another.
Verbal Bullying- when someone uses their words to hurt another, such as belittling or calling another a hurtful name
Nonverbal or relational bullying- when one person manipulates a relationship or desired relationship to harm another person. This can include social exclusion, friendship manipulation, or gossip. This type of bullying also includes intimidating another person by using gestures.
Hazing- an activity expected of someone joining or participating in a group that humiliates, degrades, abuses, or endangers that person regardless of that person's willingness to participate.
Sexualized bullying- when bullying involves behaviors that are sexual in nature. Examples of sexualized bullying include sexting, exposures or private body parts, and verbal bullying involving sexualized language or innuendos.

Anyone who sees and act of bullying and/or who then encourages it is engaging in bullying. This policy applies to all employees, contractors, and volunteers.

Bullying may show up as:

teasing
name calling
excluding others
rumors
ganging up
intentionally disrupting programs and activities
mocking or taunting

What's the impact?

The bullying behavior has a negative impact emotionally, spiritually, or physically on the victim.

Discipline Procedures

If a student does not follow the community agreements, we will take the following action steps as behavior problems progress:

Staff will redirect the student to more appropriate behavior.
If inappropriate behavior continues, the student will be reminded of the first warning they received. NCCJ staff will work with the student to decide on appropriate action steps. A phone call home may occur at this point if staff and/or student feel like this is necessary or could be helpful.
If a student's behavior continues, the student's parent/guardian will be notified, or the student may be dismissed from STARR.

Bullying incidents and action steps will be documented by NCCJ staff.

If a delegate is participating in bullying activities, the delegate's parent/guardian can be called and asked to pick up their child immediately, regardless of the time of day or day of the week.

By signing below I acknowledge that I have read, understood, and agree to the bullying policy above.

Signature

Date

Parent/Guardian Signature (if under 18)

Date

Covid-19 Liability Waiver

I acknowledge the contagious nature of Covid-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that North Carolina for Community and Justice (NCCJ) has put in place preventative measures to reduce the spread of Covid-19 and that NCCJ cannot guarantee that I will not become exposed to or infected with Covid-19. I understand that the risk of becoming exposed to and/or infected by Covid-19 may result from the actions, omissions, or negligence of myself and others, including but not limited to, NCCJ staff, program participants, and their families.

I acknowledge that I am voluntarily participating in programming provided by NCCJ and acknowledge that this increases my risk to exposure to Covid-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending NCCJ programming. I hereby release and agree to hold NCCJ harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, damages, costs, expenses, and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act by NCCJ, or that may otherwise arise in any way in connection with any services received from NCCJ. I understand that this release discharges NCCJ from any liability or claim that I, my heirs, or any personal representative may have against NCCJ with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from NCCJ. This liability waiver and release extends to North Carolina for Community and Justice (NCCJ) together with all owners, partners, employees, and program volunteers.

Signature

Date

Parent/Guardian Signature (if under 18)

Date