Broward 4-H Youth Development Program

Broward 4-H Youth Development Program Broward Parks and Recreation Division / Extension Education/ Tree Tops Satellite Administration Building 3900 SW 100th Avenue• Davie, Florida 33328 • 954.357.5270 • FAX 954.357.8740 4-H CAMP COUNSELOR APPLICATION (New CIT/Counselor)

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Name______Age______Grade______Birthdate______

Address______City______State______

Zip______Home Phone______Cell Phone______

Email Address (please print clearly)______

Please answer the following COMPLETELY (attachments are acceptable):

1) Tell us about yourself…your hobbies, interests, involvement in other groups.

2) What do you like most about working with children?

3) Why do you want to be a counselor?

4) What attributes or characteristics do you have that you believe will help you to be successful as a counselor?

The Institute of Food and Agricultural Sciences (IFAS) is an Equal Opportunity Institution authorized to provide research, educational information, and other services only to individuals and institutions that function without discrimination with respect to race, creed, color, religion, age, disability, sex, sexual orientation, marital status, national origin, political opinions or affiliations, genetic information and veteran status as protected under the Vietnam Era Veterans' Readjustment Assistance Act. U.S. Department of Agriculture, Cooperative Extension Service, University of Florida, IFAS, Florida A&M University Cooperative Extension Program, and Boards of County Commissioners Cooperating. Broward 4-H Youth Development Program Broward Parks and Recreation Division / Extension Education/ Tree Tops Satellite Administration Building 3900 SW 100th Avenue• Davie, Florida 33328 • 954.357.5270 • FAX 954.357.8740

5) Supervision is a major responsibility of a camp counselor. What are others?

6) What experience do you have in leading others?

7) Selection as a camp counselor is a competitive process. Why should we hire you?

The above application is certified to be true and accurate.

______Signature of Applicant Date Signature of Parent Date

RETURN this application and your Participation Form to Broward County 4-H NO LATER THAN Monday March 24, 2014.

The Institute of Food and Agricultural Sciences (IFAS) is an Equal Opportunity Institution authorized to provide research, educational information, and other services only to individuals and institutions that function without discrimination with respect to race, creed, color, religion, age, disability, sex, sexual orientation, marital status, national origin, political opinions or affiliations, genetic information and veteran status as protected under the Vietnam Era Veterans' Readjustment Assistance Act. U.S. Department of Agriculture, Cooperative Extension Service, University of Florida, IFAS, Florida A&M University Cooperative Extension Program, and Boards of County Commissioners Cooperating.