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CAMP COUNSELOR APPLICATION

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					 2012 AREA 5th & 6th GRADE JUNIOR 4-H CAMP COUNSELOR APPLICATION for
                            Regions 12, 17 & 18

RETURN BY April 6, 2012, TO THE HARRISON COUNTY EXTENSION OFFICE, 304
EAST 7TH STREET, LOGAN, IA 51546-1351; fax: 712/644-2100; or email to
seilstad@iastate.edu Notification of application status will be provided by April
15, 2012.

Thank you for your interest in being a camp counselor for 4-H camp. Please read this application and
then complete it carefully. The selections will be based in part on the completeness and enthusiasm
expressed in the application. Counselors must be 16 or older by June 10 for camp.




NAME                                                                       AGE

COUNTY                                 ADDRESS

CITY/TOWN                                      STATE                         ZIP

HOME TELEPHONE                                       CELL PHONE ____________________

GENDER                         Email                                    Adult TShirt Size _______

  ***YOU WILL BE REQUIRED TO ATTEND 2 TRAINING SESSIONS PRIOR TO THE CAMP
 EXPERIENCE!! They will occur in mid to Late May and Early June. Once selection has been
         made, the dates will be finalized with Jr. Camp Counselors selected.****
                                                     th  th
    Counselors will need to be available for AREA 5 & 6 GRADE JUNIOR 4-H CAMP
SATURDAY, JUNE 9-Wednesday, JUNE 13, 2012 AT THE STATE 4-H CAMPING CENTER NEAR
                                      MADRID, IOWA.
  ------------------------------------------------------------------------------------------------------------
PLEASE ANSWER THE FOLLOWING QUESTIONS:

WHY DO YOU WANT TO BE A CAMP COUNSELOR?




WHAT LEADERSHIP SKILLS DO YOU THINK ARE NECESSARY TO BE A GOOD
CAMP COUNSELOR?



(over)
WHAT DO YOU THINK THE YOUTH GAIN FROM THE CAMPING EXPERIENCES?




PLEASE LIST 2 Non-Relative REFERENCES:
INCLUDE NAMES, ADDRESSES, PHONE NUMBERS AND EMAIL.

1.




2.



Signature of Applicant
SIGNED (4-H’ER)

RECOMMENDATION OF EXTENSION STAFF
Please ask your county 4-H staff to lend their recommendation to your application:




SIGNED (COUNTY 4-H STAFF) __________________________

				
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