Application for: Work Study or Work Exchange

Period Applying for:
From: (mo/day/yr)______________ to (mo/day/yr)________________

I am applying for:
Check one: Work Study ___ Work Exchange ___

Name: __________________________________________________
Address: ________________________________________________
City, State, Zip: ___________________________________________
Home Phone: _______________Message Phone ________________
E-Mail _____________________

Are you 18 years of age or older? Yes ___ No ___
Have you ever been convicted of a felony? Yes ___ No ___
Explain:__________________________________________________

1. What is the condition of your health (physical, emotional and mental)?

2. Do you presently have any serious or life-threatening disease(s), or any other
condition, e.g. convulsions, diabetes, heart condition, etc.?

3. Is there any aspect of your physical, emotional or mental health that would be
restrictive in your daily life at the Center?

4. Please provide two references of people that are not relatives or friend.
a. Name _________________________________________
Address__________________________________________
City, State, Zip ___________________________________
Phone __________________E-Mail ___________________
Relationship _______________________Years Known ____

b. Name _________________________________________
Address _________________________________________
City, State, Zip ___________________________________
Phone __________________E-Mail ___________________
Relationship ________________________Years Known ___

5. Please provide the same contact information for your two closest relatives or friends.
a. Name____________________________________________
Address ____________________________________________
City, State, Zip ______________________________________
Phone _________________________E-Mail _______________
Relationship ___________________________Years Known ___

b. Name____________________________________________
Address _____________________________________________
City, State, Zip ______________________________________
Phone _________________________E-Mail _______________
Relationship ____________________________Years Known ___

Emergency Contact:
Please provide the Name, Address, Phone, and Relationship of those who should be
contacted in case of emergency, in the order of preference in contacting:

1. Name ____________________________________________
Address ____________________________________________
City, State, Zip ______________________________________
Relationship _________________________________________
Phone ______________________________________________

2. Name ____________________________________________
Address ____________________________________________
City, State, Zip ______________________________________
Relationship _________________________________________
Phone ______________________________________________

Please attach a resume listing education and work experience.
Please attach a sheet describing your intention and focus for this period, and what
you enjoy doing.
Applicant's Signature:

___________________________________Date___________

Mail this form with requested accompanying information to:
The Christine Center
c/o Director
W8303 Mann Rd
Willard, WI 54493

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PROGRAM GUIDELINES AND AGREEMENTS FOR WORK EXCHANGE AND WORK STUDY.

MAIL - Outgoing mail may be put in the large black mailbox on Mann Rd. The mail carrier arrives between 12:00 p.m. and 2:00 p.m. Incoming mail will be placed in your mail box or Guest mail box in the main office.

EMAIL - You may access your email account on the computer in the library, or you can bring your own laptop and use it in the library.

TELEPHONE - The phone in the Bookstore is available for credit card phone card, or local calls only.

TELEVISION - The television in the Center is available for use in the evenings unless there is a seminar going on.

VEHICLES - The Center's vehicles are to be used only for Center business. If you need a car for personal business, please speak with your supervisor. You will be responsible for any gas used and any damage that may happen to the vehicle during your time of using it. Use of the vehicle is dependent on availability and the discretion of your supervisor.

KITCHEN - If you are not going to be present for a meal, please let the cook know in advance. Fruit and hot water for tea will be available in the dining room. For access to the kitchen, permission from the cook is required. The kitchen is closed from 7:30 p.m. to 7:00 a.m. Meals include three per day.

LAUNDRY - A coin-operated washing machine and dryer is available. The cost is $1.00 for the dryer and $1.25 for the washer. It is your responsibility to supply your own detergent and to wash your bed linens.

HERMITAGE OR GUEST HOUSE - Living accommodations may vary with the needs of the Center. It is your responsibility to maintain a clean and wholesome living space.

LOCKERS - There are lockers in the bathhouse (Siloe) where you can keep your personal bathing items.

DRUGS - Smoking is not permitted in the Center buildings or vehicles. Smoking is permitted outside your hermitage or where second-hand smoke cannot possibly affect others. The use of illegal drugs is not permitted. Regular use of alcohol is discouraged.

WORK - Check with your supervisor regarding your work assignment. Work includes 35 hours of work per week, including kitchen cleanup.

Additional time or time away is allowed with prior arrangement.

Introductory term:
One month ending with a discernment process to determine the value of Work Study or Work Exchange for the individual participant and The Christine Center.

Intermediate term:
Three months ending with a discernment process.

Long term:
One year with an annual discernment process.
As a participant in the Work Study or Work Exchange program, I agree to follow
the guidelines as stated above.
Participant: ___________________________ Date: _____
Work Study Director: ____________________________________ Date: _____

The Christine Center reserves the right to conclude this agreement at any time.
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Return to:

Director
Christine Center Programs
W8303 Mann Road,
Willard, WI 54493
Phone: (715) 267-7507 Toll Free: (866) 333-7507
Fax: (715) 267-7512
Email: christinecenter@tds.net

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