Leadership Camp (Indiana) – Counselor Application

Personal Information

Name*

First Last

Mother's Name*

Father's Name*

Address*

Street Address City State ZIP Code

Home Phone Number*

e.g. 123-456-7890

Cell Phone Number

e.g. 123-456-7890

Phone Number of Parent (emergency use only)*

e.g. 123-456-7890

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 / Minuteman

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

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.

Reference*

Who recommended this program to you?

Comments

Essays

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

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