Leadership Camp (PA) – Counselor Application Personal InformationName* First Last City* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificHome Phone Numbere.g. 123-456-7890Applicant Cell Phonee.g. 123-456-7890Applicant Email* Date of Birth* Month Day Year School InformationSchool* Grade (entering next fall)* Camp InformationHave you attended the Leadership Camp before?* As a camper As a counselor As both As neither MiscellaneousReference Who recommended this program to you?Comments