Leadership Lab Counselor Application
Email address *
Name *
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Cell Phone Number *
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Birthdate *
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Current institution where you are enrolled
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Year in college: *
Required
Please provide the name of two references. If your references do not work at NA, please also provide an email address and phone number. All references will be contacted. *
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Current employer (if applicable), please include your supervisor's name, phone number, and email address:
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What will make you an asset to Leadership Lab? *
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What are your hobbies/interests/extracurricular activities? *
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Do you have any special licensures (CPR, Lifeguard, etc.)? If so, please email a copy to bmcmahon@norfolkacademy.org *
Required
Have you ever been convicted of anything other than a minor traffic violation or do you have any felony charges outstanding? *
Required
If YES, please explain:
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By typing my initials below, I give Norfolk Academy permission to do a criminal history and a social service registry search.
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By typing my initials below, I confirm that the above information is correct to the best of my knowledge.
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A copy of your responses will be emailed to the address you provided.
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