MYGD × Miftaah Summer Camp: Counselor Application

(Note: this form is for prospective counselors. If you wish to register as a regular attendee, please see here.)

Full name *

Email *

Gender *

Phone number *

Which community are you from? *

Date of birth (mm/dd/yyyy) *

Age *

Driver's license number *

Street address *

City *

State *

ZIP code *

Attending college? *

College name

Will your work commitments prevent you from being part of the camp? *

Work Experience 1 – Company Name

Start date (mm/dd/yyyy)

End date (mm/dd/yyyy)

Position

Work Experience 2 – Company Name

Start date (mm/dd/yyyy)

End date (mm/dd/yyyy)

Position

Volunteer Experience 1 – Organization Name

Start date (mm/dd/yyyy)

End date (mm/dd/yyyy)

Position

Volunteer Experience 2 – Organization Name

Start date (mm/dd/yyyy)

End date (mm/dd/yyyy)

Position

Personal or professional reference 1 – full name *

Phone number *

Personal or professional reference 2 – full name *

Phone number *

Will you be taking any college course or exams during camp? *

Why are you interested in applying to volunteer at our camp? *