*Applicants must be 2 years out of high school to apply for staff.
First Name: MI: Last Name: Sex: Male Female Date of Birth Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 Year of High School Graduation: Age: Home Address: City: State: ZIP:
***The school information is for those potential staff members who may still be in college at the time staff applications are being accepted. If this information does not apply to you, please insert NA into those blanks. School Address: City: State: ZIP: Home Phone: School Phone: E-mail: Marital Status: Married Single Occupation: Do you play guitar?: Please Select Very Well Fair No Do you play keyboard?: Please Select Very Well Fair No Are you trained in First Aide? Yes No Are you trained in CPR? Yes No Have you made Higher Ground? Yes No When: Have you made Higher Ground II or III? Yes No When: Have you worked HG, HG II or HGIII? Yes No When: Parish: Select Parish Out of Diocese All Saints All Souls Assumption of the BVM Blessed Sacrament Cathedral of the Nativity of the BVM Catholic Newman Center at UNK Christ the King - Cozad Christ the King - Gering Church of the Nativity of the BVM Good Samaritan Hospital Holy Cross Holy Rosary - Alliance Holy Rosary - Overton Holy Spirit Immaculate Conception - Elm Creek Immaculate Conception - Rushville Mount Carmel Home-Keen Memorial Our Lady of Good Counsel Our Lady of Guadalupe - Hershey Our Lady of Guadalupe - Scottsbluff Our Lady of Lourdes Our Lady of Mount Carmel Our Lady of Perpetual Help Prince of Peace Resurrection Sacred Heart - Sutherland Sacred Heart - Burwell Sacred Heart - Ansley Sacred Heart - Bayard Sacred Heart - Greeley Sacred Heart - Lyman Sacred Heart - Mirage Flats Sacred Heart - Lodgepole Sacred Heart - Shelton St. Agnes - Arnold St. Agnes - Scottsbluff St. Ann - Lexington St. Ann - Morrill St. Anselm-St Paul St. Anthony of Padua St. Boniface St. Bridget St. Columbkille St. Elizabeth St. Francis St. Francis Medical Center St. Gabriel St. Gall St. James St. Joan of Arc St. John Capistran St. John Evangelist St. John the Baptist St. Josaphat St. Joseph St. Joseph - Broken Bow St. Joseph - Elba St. Joseph - Kimball St. Joseph - Wolbach St. Leo - Gordon St. Leo - Grand Island St. Libory St. Luke St. Mary - Dalton St. Mary - Mullen St. Mary - Nenzel St. Mary - Oconto St. Mary - Pleasanton St. Mary - Prairie Center St. Mary - Rockville St. Mary - Wood River St. Mary Convent St. Michael St. Nicholas St. Patrick - Chadron St. Patrick - Eddyville St. Patrick - North Platte St. Patrick - Paxton St. Patrick - Scotia St. Patrick - Sidney Sts. Peter and Paul St. Pius X St. Theresa - Ericson St. Theresa - Mitchell St. Thomas St. Thomas of Canterbury St. Wenceslaus Pastor's Name: Select Priest Out of Diocese Abele, Rev. Joseph P. Augustyn, Rev. Andrew M. Bauer, Rev. Jacob F. Berger, Rev. Bernard M. Borzych, Rev. Alex J. Buhrman, Rev. Donald A. Carlson, Rev. Gerald J. Chamberlain, Rev. Robert F. Chavez, Rev. José M. Colling, Rev. Paul J. Cook, Rev. John N. Cortney, Rev. Edward P. Coulter, Rev. Lawrence W. Curran, Rev. Francis T. Deaver, Rev. Stephen F. Dendinger, Most Rev. William J. Dennett, Rev. John A. Dillon, Rev. Thomas J. Egging, Rev. Martin L. Ernest, Rev. Bryan D. Faesser, Rev. Arthur A. Fenton, Rev. Lawrence E. Ferris, Rev. Carl L. Flott, Rev. Phillip Golka, Rev. James R. Guevara, Rev. Miguel H. Hannappel, Rev. Joseph A. Harr, Rev. Gerald J. Hayden, Rev. Msgr. Carl T. Heithoff, Rev. James H. Hunt, Rev. James M. Janovec, Rev. James J. Karnish, Rev. Robert A. Koperski, Rev. Matthew J. Koprowski, Rev. Mitchell J. Kosmicki, Rev. Raymond M. Kremeier, Rev. James A. Krystosek, Rev. Robert Kurtenbach, Rev. Harold R. Larmore, Rev. Donald E. Maresh, Rev. Mark A. McDermott, Rev. Michael F. McDonald, Rev. Michael D. Mullowney, Rev. Thomas E. Murphy, Rev. James E. Nekoliczak, Rev. Ted A. Nollette, Rev. Jouis A. Nollette, Rev. Neal P. Novakowski, Rev. James E. O'Brien, Rev. Donald J. O'Connor, Rev. Jim O'Kane, Very Rev. James D. Parsons, Rev. Vincent L. Phelan, Rev. Walter M. Philipsen, Rev. Todd K. Phillips, Rev. Walter W. Piontkowski, Rev. Richard L. Pohlmeier, Rev. Loren G. Pruss, Rev. Rodney L. Rademacher, Rev. John R. Rooney, Rev. Robert B. Ryan, Rev. Thomas A. Rykwalder, Rev David L. Schlaf, Rev. John E. Schmitt, Rev. James C. Smutny, Rev. Jan Spanel, Rev. Hubert J. Stoner, Rev. Timothy L. Torpey, Rev. Charles L. Warner, Rev. James P. Whalen, Rev. Joseph E. Pastor's Mailing Address (Don't Know? Click Here!) : City: State: ZIP: Please choose a t-shirt size (cost is included in registration cost): Please Select Small Medium Large X-Large XX-Large XXX-Large Choose one of the following programs: (required) HIGHER GROUND
HIGHER GROUND II
Week 1: May 30-June 4, 2010
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