E-mail address

Current Address

City	State	Zip

Current Phone

College or University attending/Education, Major, Degree

Year In College

Camp Experience

Which activities would you be qualified to instruct?
	Arts & Crafts		Golf		Soccer
	Archery		Lifeguarding/Swim instruction		Softball
	Baseball		Riflery		Tennis
	Basketball		Roller Hockey		Windsurfing
	Fishing		Ski boat driver		Waterskiing
	Football		Sailing		Volleyball

Details of any swimming instructor or lifesaving certificates (Red Cross, etc.) Give Dates.

Have you ever been convicted of any crime including sex related or child abuse related offenses?
Yes
No

What three things about you would make you a good counselor?

What one "flaw" in your personality do you wish to change most?

What role do you think competition should play at Camp?

What do you think a child should gain from a summer at Camp?

Write a brief autobiographical sketch, including specialized training or experience in organized Camping, experience with children, and training or experience in other fields which would have bearing on a position at Camp Menominee.