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* 1. Position for which you are applying: Indicate your first and second choices.

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* 2. Last Name:

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* 3. First Name:

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* 4. Birth Date (MM/DD/YY):

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* 5. Age:

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* 6. Gender:

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* 7. Address:

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* 8. T-Shirt Size (Unisex):

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* 9. Status of Hearing Loss:

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* 10. Method of Communication:

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* 11. Expressive Skills:

  Excellent Good Fair N/A
American Sign Language (ASL)
Signed Exact English (SEE)
Spoken English

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* 12. Receptive Skills:

  Excellent Good Fair N/A
American Sign Language (ASL)
Signed Exact English (SEE)
Speech Comprehension
Lipreading

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* 13. Camp Skills (OPTIONAL)

  I can organize and teach this as an expert I have a related certification (you MUST attach a copy) N/A
Archery
Arts and Crafts
Drama
Field Sports
Fitness and Exercise
Hiking
Horseback Riding
Karate
Lake Activities
Leadership Training
STEM (Science, Technology, Engineering, Math)
Swimming
Team Building
Yoga

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* 14. Additional Certifications:

  YES N/A
Cardiopulmonary Resuscitation (CPR)
First Aid
Water Safety Instruction or Lifeguard

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* 15. Essay #1 : What kind of role model do you think you would be? How will you serve as this role model?

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* 16. Essay #2: Write a brief biographical sketch, including specialized training in camping, and experience or training in other fields related to the position(s) for which you are applying.

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* 17. Education Information:

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* 18. Education Information continued:

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* 19. Education Information continued:

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* 20. Education Information continued:

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* 21. Employment and Camp Staff Experience: List most recent position first.

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* 22. Employment and Camp Staff Experience:

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* 23. Employment and Camp Staff Experience:

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* 24. References: List three people who know you and your abilities.  Do not include family members!

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* 25. I certify to the best of my knowledge that the information given in this application is true and correct, and that I will follow the policies of Camp Sign.

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