Counselor Application: campJacob 2017

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Dear Applicant,

Please take a moment to review our 2017 campJacob Volunteer Guide before completing this application. The Volunteer Guide can be found attached to this email as a PDF or as separate link. The deadline to complete this application is December 15, 2016.

campJacob 2017 is Wednesday, July 12 - Sunday, July 23, 2017.

Thank you for your interest in campJacob 2017!

Last Name (as it appears on your passport) *

First Name (as it appears on your passport) *

Date of Birth *

YYYY

Age *

Sex *

Male

Female

Required

Email *

Mobile Phone Number *

*numbers only

Alternate Phone Number

Street Address *

City *

State *

Zip Code *

Employer *

Title/ Profession *

Departing Airport: *

Airport Name or City/ State

Do you have a valid US or Canadian passport? *

Note: A valid passport must have at least 6+ months validity at the time of travel.

Yes

What is your US or Canadian passport number? *

What is the issue date of your US or Canadian passport? *

What is the expiration date of your US or Canadian passport? *

Language Skills:

English

French

Creole

ASL

FSL

Spanish

Other

Please choose one: *

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