Counselor Application: campJacob 2017
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!
* Required
Last Name (as it appears on your passport)
*
Your answer
First Name (as it appears on your passport)
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Age
*
Your answer
Sex
*
Male
Female
Required
Email
*
Your answer
Mobile Phone Number
*
*numbers only
Your answer
Alternate Phone Number
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Employer
*
Your answer
Title/ Profession
*
Your answer
Departing Airport:
*
Airport Name or City/ State
Your answer
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
No
What is your US or Canadian passport number?
*
Your answer
What is the issue date of your US or Canadian passport?
*
Your answer
What is the expiration date of your US or Canadian passport?
*
Your answer
Language Skills:
English
French
Creole
ASL
FSL
Spanish
Other
Please choose one:
*
Choose
New Counselor
Returning Counselor
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