Please fill out the form below and press "submit" to send us your application.

Date of Birth

Desired Sessions

Background
Select the highest level you've completed.
Have you ever been convicted of a felony or misdemeanor?
Have you ever been convicted of a child abuse or a sexual offense?

Certifications

If yes, please send a copy of your card with the required medical form.

If yes, send a copy of your card with the required medical form.

If yes, send a copy of your card with the required medical form.

Parents/Guardians

Provide information of at least one parent/guardian.


Emergency Contacts

You must provide a back-up Emergency Contact unless there are multiple parents / guardians listed in the previous section.


Transportation

References

* New counselors must complete this section (optional for returning counselors).

Provide three adult references (not relatives or peers) who have knowledge of your character, experience and ability.