Day Camp: Camp Dates:
DayCamp Contact: Nicole von Trotha
PLEASE PRINT:
CampName:
Name:Birth date Grade in Fall
Address:CitySt. Zip
Home Phone:( ) E-mail:
POSITION APPLYING FOR:
Camp:Position:
When & Where did you obtain Program Aide Training:
CORE PA Training: Date Place Trainer
Describe your 25 hours of PA Internship:
PA Specialist Training: (check those completed, describe service given to complete internship.)
CampSkills 25 hrs Internship:
Outdoor Skills 25 hrs Internship:
OTHER25 hrs Internship:
List any camping or leadership experiences you have had:
Agency/OrganizationType of ExperienceDates
To
To
To
List any extra-curricular activities or clubs you belong to:
Have you attended Girl Scout Resident Camps, Community Camp, or Day Camp before? If yes, what programs did you attend?
Please indicate certificates you may hold and expiration dates:
Standard First AidExpiration DateLifeguarding Expiration Date
Advanced First AidExpiration Date Water Safety Instructor Exp.Date
CPRExpiration Date Small Craft Safety Exp Date
OtherExpiration Date OtherExp. Date
As a Young Adult in Girl Scouting, what programs or training opportunities have you completed ?
Cadette Leadership Award Senior Leadership Award
Cadette 4 Bs Challenge Senior 4 Bs Challenge
Silver Award Describe Counselor In Training I (CIT) CIT II
Leader In Training (LIT)
LIT Internship LIT Mentorship
Sr. Planning Boardoffice? Gold Award Describe
Other:
Other Girl Scout Achievements:
Why do you think you should be selected for the Program Aide program?
What are your personal goals for the summer of 2011?
Please describe your experience working with children?
As a Program Aide you may be asked to specialize in one area. Please note in which area you would like to specialize? (List 3, in order of preference) Expand on why for each choice, below the checklist.
______Unit Helper - Daisy ______Unit Helper – Brownie Unit Helper – Junior
______Fire______Tools Knots
______Cooking______Songs and Games Preschool
Other (______)
WHY do you choose theses areas? 1)
2)
3)
REFERENCES: Please list someone, not related to you, who has definite knowledge of your qualifications for the program you are applying. (NOTE: Please type or print complete name of person, legibly.)
NameRelationship
Phone ( )Email:
Please mail the enclosed reference form to the person you listed above. Ask them to send the forms back IMMEDIATELY, and directly to the Camp contact listed on the reference form. One reference is required of each applicant.
Leadership at camp is of vital importance. The purpose of the Program Aide program is to provide quality, comprehensive leadership training for future camp counseling and/or other leadership roles. I understand that a Program Aide is still a camper and I agree to abide by the rules and regulations affecting campers and the code of conduct.
______
Signature of ApplicantDate
______
Signature of Parent / GuardianDate