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Counselors

To Apply for Counselorhip select paper application below or enter your information in our online form:

Expand panel below for traditional forms.

Click here for New Counselor Application - Paper Application

Join our group of volunteer youth counselors, and help make a positive difference to children with hearing loss and their siblings. You must be at least 18 years old to apply. All applications and reference information will be reviewed and subject to approval by House Research Institute's Director of Community Education & Outreach.

Click for PDF application

Click here for Returning Counselors - Paper Application

(If you are under 18 years of age, you must be accompanied by a parent or guardian on that weekend)
First name Last name Age
Address
City State Zip Code
Phone or TDD (555-555-5555) Type
email address
email address (confirmation)
Level of hearing
Level of communication (check all that apply)

Oral American Sign Language Cued

Age Group preferred to work with (check all that apply)

ASL Skill Level
What is your fitness level?

*Are you currently in High School or College? Yes No

College or High School Name

Major or Coures of Study
School counselor's name:
School counselor's phone number: (555-555-5555)

If not, what is the last level of education that you've completed?:
If currently employed, please list place of employment

*Are you a returning counselor? Yes No

Last Year of Camp Attendance (e.g. 2003)

Have you ever been arrested?
Yes No
If yes was answered, please explain.
List below at least 3 references. There should be at least one teacher or guidance counselor; if you have been or are currently employed, please list employer.
Reference 1: Phone:
Relationship:
Reference 2 Phone:
Relationship:
Reference 3 Phone:
Relationship:
List any special skills you have that may be helpful at camp: List any previous counselor experience:

List any camps you have attended:

Do you have any experiance working with children?
T-shirt Size

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Counselors To Apply for Counselorhip select paper application below or enter your information in our online form:

Counselors

To Apply for Counselorhip select paper application below or enter your information in our online form: