Junior Counselor Application Form - 2017 Page 6
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12REFERENCES
List names/addresses of three people (not relatives) having knowledge of your character experience and ability.
Give each of these people one of the attached reference forms to be filled out and forward to the return address.
NAME
ADDRESS
PHONE
I certify that all information provided on this application is true and complete. I understand that falsification or
significant omissions of any information may be considered justification for release from the Junior Counselor
program if discovered at a later date.
_________________________________________________________________
____________________
Signature
Date
JCApplication2017
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