Leadership Camp (PA) – Counselor Application

Personal Information

Name*

First Last

Mother's Name*

Father's Name*

Address*

Street Address City State ZIP Code

Home Phone Number*

Cell Phone Number

Phone Number of Parent*

Email Address – Student*

Email Address - Parent

Required if you are under 18

Date of Birth*

School Information

School*

Grade (entering next fall)*

Grade Point Average*

Extracurricular Activities*

Camp Information

Have you attended the Leadership Camp before?*

As a camper
As a counselor
As both
As neither

Which position are you applying for?*

Senior Counselor
Junior Counselor / Mariachi

Are you a certified lifeguard?*

Yes
No

Miscellaneous

Shirt Size*

These are adult sizes.

Any special diet requirements?*

Any special medical issues?*

Center*

Which center do you attend?

Center - Other*

Please specify

Electronic Signature for Photo Release and Communication

Parents must sign for applicants under 18 years of age.

I hereby authorize and consent to the use and reproduction by YSI staff or an authorized agent or assignee of any and all photographs taken of the above-named applicant for the purpose of promoting YSI programs, without any compensation to me. All film, together with any prints, shall constitute property of YSI, solely and completely. I also give permission for program staff to contact the applicant for program specific purposes.

Comments

References

Please provide the information for one reference we can contact about you. A reference can be a teacher, supervisor, or a family member.

Name*

First Last

Reference Type*

Phone*

Email*

Essays

Why do you want to work at the Leadership Camp?*

50-75 words

What experience do you have that would make you a good candidate for the role indicated above?*

50-75 words

What qualities do you think are necessary to be a truly good leader?*

50-75 words

Two core responsibilities of counselors are serving others and forming campers. Please describe how you have lived dedication to your own formation at the center you attend and how you have lived a spirit of service at the center.*

50-75 words