2014 Discovery Days Floor Counselor Application

The Discovery Days Floor Counselors will help delegates have a positive, safe residence hall experience. Discovery Days will be held June 3-6, 2014 with the expectation that Counselors will attend for 5 days and 4 nights beginning on June 2 for training and staying until the morning of June 6.

Full Name

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Address

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City

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State

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E-mail Address

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Cell Phone Number

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Date of Birth

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Your Current Age

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What is your Gender?

Male
Female

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Have you served as a Floor Counselor in the past?

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Are you a past 4-H'er?

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If Yes, what Local Extension Unit were you a member of?

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Have you attended Discovery Days in the past?

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If Yes, what years?

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Why do you want to be a Floor Counselor at the 2014 4-H Discovery Days?

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What experience do you have in supervising young people?

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References

In the following section we will ask for the names and contact information for two people that we can contact about your past work experiences.

Name of Reference #1

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Title of Reference #1

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Phone Number of Reference #1

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How long and in what respect have you known Reference #1?

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Name of Reference #2

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Title of Reference #2

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Phone Number of Reference #2

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How long and in what respect have you known Reference #2?

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