201 5 4-H CAMP COUNSELOR APPLICATION
Position - First Year Applicants only check CIT. Returning Counselors check all that you are eligible.
Teen Director (16-18 with 2 years’ experience as Tribe Leader) _____
Tribe Leader (15-18 years) _____
Assistant Tribe Leader/ Cabin Leader / Activity Leader (14-18 years) _____
Counselor-in-Training CIT (13 now,14 by June 1, 2015 or 15-18 First Year Counselor) _____
Name ________________________________________________
Age as of 1/1/15 _______________
Birth Date __________
Address _
Parents / Guardians Name ________________________
Parent/Guardian Cell Phone or Home Phone __ _
Your Cell Phone __ _
Your Email Address _ _
Parent/Guardian Email Address _ _
School____ Current Grade ________________________
Race Data: this information is requested on an optional basis. Your cooperation in providing it is appreciated. Please check the box that indicates your race which will be used only for reporting purposes.
Native American _____
Asian :_ ____
Hispanic _____
Black _____
White _____
Number of years attended 4-H Junior Camp as a Camper _____
Number of years attended 4-H Intermediate Camp as a Camper _____
List number of times you have served as each of the following, specifying Junior/Intermediate Camp:
# times as Cabin / Activity Leader: _____
# times as Counselor-in-Training (CIT):_ ____
# times as Tribal Teen Leader: _____
# times Teen Director: _____
List Other Camp Experiences and Your Role (Day Camp, Sports, Girl Scouts, Boy Scouts, Specialty)
.
Describe your background in 4-H other than Camp. Include Club, Projects, Officer Positions, County/State Participation, etc.
In 4-H the four H’s represent HEAD, HEART, HANDS, HEALTH. Describe how each of these relates to 4-H Camp. (If you are not a 4-H’er research to find the “4-H Pledge”.)
What do you think is the “MISSION” of the Harford County 4-H Camp?
Why do you want to serve as a 4-H Camp Counselor?
What do you feel is the role of the adult volunteers at Camp? How does your position as a Camp Counselor relate?
Extra-Curricular Activities
1. School:
2. Community:
3. Leadership positions held in school, sports teams, youth organizations (non 4-H) or in the community (include assistant positions held with adults). Please include as much information as possible.
4. Service Learning (Community Service):
5. Hobbies/Hidden Talents:
Describe any experiences working with younger youth, other than Camp. Include what you like most when working with younger youth and with what age group you prefer to work.
Describe the role of a mentor, a coach and a leader. How does each relate to being a Counselor?
Explain why you will be successful as a Camp Counselor. Include at least three personal characteristics you have that will assist you in being an asset to our program.
Name one personal characteristic that you feel you could improve that will make you more effective as a Counselor.
If you are chosen as a Counselor, list at least three goals you hope to accomplish.
What part of serving as a Counselor do you think will be most challenging?
List some experiences that you have had that prepared you to be a Camp Counselor.
If you held a camp Teen Leader position last year, in what way did you help the Campers have a memorable experience?
.
What do you think is your role as a teen leader at Camp regardless of your specific assignment?
What training will assist you in being prepared for your role as a Camp Counselor?
What role does the American Camping Association have at the Harford County 4-H Camp?
.
If you are accepted, which activities would you like to assist with?
_____ Crafts _____ Riflery _____ Newspaper _____ Sports
_____ Archery _____ Drama _____ Hiking _____ Outdoor Cooking
_____ Nature Activities (specify)
** DIRECTOR APPLICANTS ONLY: Explain why you should be chosen as a Teen Director.
Training and/or certificates you already have:
_____ Red Cross First Aid Certification _____ Red Cross Certified Life Guard
_____ Water Safety Instructor _____ CPR Certification
_____ Know basic sign language ____ Can Swim _____ Cannot Swim
___-__ Other (please list)
Please supply contact information for two non-family references:
Name: _ _____ Phone /Email __ _
Name: _ ______ Phone / Email __ ___
Are you available for the following camps?
Junior Camp – June 28-July2
Intermediate Camp – J uly 12-17
In completing and submitting this application, I understand that there is an obligation to attend and participate in the planned camp staff trainings. I also understand that my selection to participate as a camp youth staff member is based upon many criteria: C ompletion of A pplication; C hecking R eferences; Per sonal I nterview; C amp and L eadership E xperience; B ackground in W orking with Y ounger Y outh; A ge, as stipulated under the ACA Camping Standards; Attending 32 hours of Mandatory T raining S essions ; and Adhering to 4-H and Camp Behavior Expectations .
_________________________________________ ______________________________________
Youth Signature Parent Signature
____________________
Date
University of Maryland Extension programs are open to all and will not discriminate against anyone because of race, age, sex, color, sexual orientation, physical or mental disability, religion, ancestry or national origin, marital status, genetic information, political affiliation, or gender identity and expression.