2024 Counselor in Training Application

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Hertko Future Leader Application

Counselor in Training (CIT)
Must be 17 yrs. of age

Name *

Phone Number *

Street *

City *

Zip *

Email *

Birthdate *

YYYY

Age (as of June 1, 2023) *

Current grade in school *

Gender *

Male

Female

Non-binary

Other:

Have you participated in Camp Hertko Hollow’s LIT program?
*

Yes

Do you have diabetes? *

Type 1 Diabetes

Type 2 Diabetes

What age were you diagnosed?

Statement of Understanding: In applying for the Hertko Future Leader program as a CIT, I am aware that my status during the week at CHH is camper. My role at camp will allow me to stay in a cabin during kid’s week and shadow CHH camp counselors to comprehend and experience first-hand experience in my future role as a diabetes camp counselor at CHH when eligible. I will focus on the camper’s in my cabin with the guidance of the CHH camp counselors and HFL coordinator. My goal will be to demonstrate my desire to help kids with diabetes and use my leadership skills to impact those around me in a positive way.
*

I understand

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