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MYNA DMV Region Winter Camp 2013- Counselors Application

1. MYNA Camp Counselor Commitment Document and Application Form

This application must be completed regardless of previous counseling experience with MYNA Events. There is no registration costs for counselors. For more information you may contact camp@myna.org.

As a MYNA Camp Counselor I will:

1. Follow MYNA code of ethics that includes abiding by MYNA’s vision, mission and policies

2. Abide by MYNA Youth Protection Policy

3. Take full responsibility of the youth I am assigned to by Camp Advisor, including accompanying my group for the duration of the camp.

4. Attend MYNA Camp Counselor training to be held by MYNA National

5. Be willing to take other responsibilities that Camp Advisor might give me when need occurs

As a MYNA camp Counselor, I understand that the Human Resources officer at the Islamic Society of North America (ISNA) will contact me to ask for my social security number. I authorize ISNA to use my information, including my social security number, to run a background check on me.

I also undertstand that if travel arrangements are made for me by MYNA National and I cancel, I will be subject to reimburse the organization for the travel expenses.

* 1. Counselor's Information

First Name

Last Name

Gender

Birthdate

Address

City

State

Zipcode

Phone

Current Employer

Position

Highest level of completed education

* 2. Medical Training:
Are you CPR certified?

yes

* 3. Are you trained in a medical profession? (doctor, nurse, paramedic)?

yes

Please specify:

* 4. Expiration date of CPR/First Aid training certificate

* 5. Please describe in approximately 75 words why you want to be a counselor (we are looking for specific, passionate, well thought out answers).

* 6. Experience:
Have you ever attended a MYNA camp (or other youth camps/conference) as any of the following? Please mark all that apply.

Speaker

Counselor

Participant

If you marked any of the above then how many?

* 7. Have you ever been convicted of a crime other than a minor traffic offense? If yes, please describe

Yes

* 8. If you answered Yes to the question above, please explain here

* 9. Have you been a counselor at the 2012/2013 Summer or Winter camps?

yes (If selected you will be automatically forwarded to the next page)

* 10. Experience (2):
Do you have any other experience working with young people? (teaching, mentoring, etc)

* 11. Role Model:
Do you believe that a camp counselor should be a role model for camp participants at the camp and afterwards? Do you feel that you would be a good role model? Why?

* 12. Islamic Studies Resume:
How would you describe your knowledge of Islam and the Quran? Please describe in detail (consider this your "Islamic Studies Resume", describe any programs you have attended, teachers you have studied with , etc.)

* 13. What is your favorite book relating to Islam and Muslims?

* 14. When kids leave the MYNA camp, and they are asked, what was the most memorable part of camp for them, what would you want them to say?

* 15. What do you think that you can specifically bring to enhance the MYNA camp?

* 16. If you had the opportunity to enhance the program at this event, whether in the form of a khatira, main lecture, creativity-oriented workshop, or a practicality/career-oriented workshop, would you feel comfortable contributing to the camp as a speaker? If so, what topics would you feel comfortable speaking about and what past experience do you have in this regard?

* 17. Do you partake in any forms of physical fitness activities? Do you play any sports? If so what, and at what level have you competed?

* 18. What other extra-curricular activities/hobbies have you been involved with, both inside and outside of the Muslim community? (example: Social activism, MSA work, political organizing, painting/calligraphy, etc.)