P.O. Box 287 Fort Washington, PA 19034 Email: summer@gacamp.org
Telephone: 267.405.7321 Fax: 267.405.7184
Counselor in Training Questionnaire Name: ________________________________________________
Age: __________
School: _______________________________________________
Grade: ________
Phone Number ________________________
Email: ___________________________
Best Method of Communication (please circle one):
Phone
Will you attend all six weeks of the program? (Circle one) YES NO If not, please check the weeks you will attend. (A minimum of 4 weeks is required) _____ Week 1: June 25-29
_____ Week 2: July 2-6
_____ Week 3: July 9-13
_____ Week 4: July 16-20
_____ Week 5: July 23-27
_____ Week 6: July 30-Aug. 3
* Due to the nature of the program, attendance for all six weeks is strongly encouraged. Dear Applicant, Please fill out this questionnaire to help me determine your level of interest in the CIT Program. I wish to ensure that the applicants selected both contribute to and receive the most from our program. Because space is limited, please return the questionnaire as soon as possible to my attention at the address above. The deadline for applications and recommendations is April 30, 2012. I will contact you after receiving and reviewing applications. I look forward to learning more about you. Attention: Attached are two recommendation forms. Please give them to two non-family members who know you very well. A current teacher is required to complete one of the forms. Please have the evaluators return these forms as soon as possible to the attention of Summer Programs at the address above by April 30th. Thank you, Joanna Stahl CIT Program Director joanna.stahl@gacamp.org 1. Why do you want to be a CIT?
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