Become a Counselor

Applicant Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Todays Date*

Phone*

Email*

Email used to send your copy of the completed application.

May we share contact info with other team members?*

Yes
No

Major

College

High School

Grade

Interests / Hobbies*

Strengths*

Weaknesses*

What would make you an asset to the team?*

Other information if necessary

Summer availability*

Planned vacations

Shirt size*

Small
Medium
Large

Select an option.

Short size*

Small
Medium
Large

Select an option.

Experience

Please include company names, dates, and positions.

Experience working with children*

Other work experience*

About Me

Things that motivate me*

Three positive personality traits*

Something I want you to know about me*

Three interesting things about me*

Interests

Interests / Hobbies*

IE: baking, crafts, working out, etc.

Strengths / Talents*

IE: juggling, writing, etc.

In my spare time I like to*

Something I would like to learn*

IE: crocket, sign language, etc.

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Interest in joining the Clubhouse?

Applicant Information

Experience

About Me

Interests