Junior Counselor Application Form - 2017 Page 3
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12Girl Scout Council of the Nation's Capital
APPLICATION FOR JUNIOR COUNSELOR
Qualifications:
th
th
Be a registered Girl Scout completing 11
or 12
grade.
•
16 years of age or older
•
Have demonstrated an interest in working with children in camp setting.
•
Have a real interest in the progress and welfare of younger Girl Scouts.
•
Demonstrate a willingness to accept all people and work with them, regardless of race, religion, or
•
ethnic background.
Enjoy the out-of-doors and those activities associated with camping.
•
Instructions:
* Please type or print clearly.
* Return to Emily Reece, Camping Specialist, GSCNC, 4301 Connecticut Ave., N.W., Washington, D.C. 20008,
along with names of three people you have given reference forms to (see below) by February 10, 2017 at 12:00
NOON.
Name______________________________________________ Phone________________________________
Your Camp Name (nickname) _________________________ Email_________________________________
Skype Address _____________________________________
Address _________________________________________________________________________________
City__________________________________________________________ State________ Zip___________
Birth Date ___/___/___ School Attending ________________________ Grade completing (spring 2017) ____
Group/Troop # ______ or Individual Girl Member # ________ Association/Service Unit _____________
Leader/Advisor ____________________________________________ Phone # ________________________
# of Years in Girl Scouting as a Girl Scout:
Daisy
_____
Cadette
_____
Brownie
_____
Senior
_____
Junior
_____
Ambassador
_____
TRAINING
Do you have a current first aid certificate? If so, check the kind you have and list expiration date:
First Aid (Date of expiration: _____________) Title of Course ____________________________________
CPR (Date of expiration: _______________) Title of Course ____________________________________
Other Training Courses:
1. Title of Course: ______________________________ Type of Certification: _________________________
Training Organization: ___________________________________
Date of expiration: ___/___/____
2. Title of Course: ______________________________ Type of Certification: _________________________
Training Organization: ___________________________________
Date of expiration: ___/___/____
JCApplication2017
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