1. Camp Name * (Required)
2. Camp Director's Name * (Required)
3. Camp Phone Number
4. Camp Fax Number
5. Camp Email
6. Your Position at Camp * (Required)

Personal Information (as it appears on your passport)

1. First Name * (Required)

   This is your first name or given name as appears on your passport

2. Middle Name
3. Last Name * (Required)

   This is your last name or Family name as it appears on your passport

4. Date of Birth * (Required)

   Month Select month January February March April May June July August September October November December Day Select day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year Select year 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
5. Earliest date you can fly to the U.S. * (Required)

   Month Select month January February March April May June July August September October November December Day Select day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year Select year 2010
6. Latest date you can stay in the U.S. * (Required)

   Month Select month January February March April May June July August September October November December Day Select day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year Select year 2010
7. Gender * (Required)

   Male Female
8. Country of citizenship * (Required) Select Country Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Aruba Ashmore And Cartier Islands Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Bassas Da India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic Of Cook Islands Coral Sea Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Europa Island Falkland Islands (Islas Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern And Antarctic Lands Gabon Gambia, The Gaza Strip Georgia Germany Ghana Gibraltar Glorioso Islands Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island And Mcdonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle Of Man Israel Italy Jamaica Jan Mayen Japan Jersey Jordan Juan De Nova Island Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Martinique Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Zealand Neutral Zone New Caledonia Nicaragua Niger Nigeria Niue Norfolk Island North Korea Norway Oman Pakistan Palau Panama Paracel Islands Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre And Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia And The South Sandwich Islands South Korea Spain Spratly Islands Sri Lanka Stateless Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tromelin Island Tunisia Turkey Turkmenistan Tuvalu Turks And Caicos Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis And Futuna West Bank Western Sahara Yemen Zambia Zimbabwe
9. Country of legal residence * (Required) Select Country Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Aruba Ashmore And Cartier Islands Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Bassas Da India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic Of Cook Islands Coral Sea Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Europa Island Falkland Islands (Islas Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern And Antarctic Lands Gabon Gambia, The Gaza Strip Georgia Germany Ghana Gibraltar Glorioso Islands Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island And Mcdonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle Of Man Israel Italy Jamaica Jan Mayen Japan Jersey Jordan Juan De Nova Island Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Martinique Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Zealand Neutral Zone New Caledonia Nicaragua Niger Nigeria Niue Norfolk Island North Korea Norway Oman Pakistan Palau Panama Paracel Islands Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre And Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia And The South Sandwich Islands South Korea Spain Spratly Islands Sri Lanka Stateless Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tromelin Island Tunisia Turkey Turkmenistan Tuvalu Turks And Caicos Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis And Futuna West Bank Western Sahara Yemen Zambia Zimbabwe
10. City of birth * (Required)
11. Country of birth * (Required) Select Country Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Aruba Ashmore And Cartier Islands Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Bassas Da India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic Of Cook Islands Coral Sea Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Europa Island Falkland Islands (Islas Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern And Antarctic Lands Gabon Gambia, The Gaza Strip Georgia Germany Ghana Gibraltar Glorioso Islands Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island And Mcdonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle Of Man Israel Italy Jamaica Jan Mayen Japan Jersey Jordan Juan De Nova Island Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Martinique Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Zealand Neutral Zone New Caledonia Nicaragua Niger Nigeria Niue Norfolk Island North Korea Norway Oman Pakistan Palau Panama Paracel Islands Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre And Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia And The South Sandwich Islands South Korea Spain Spratly Islands Sri Lanka Stateless Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tromelin Island Tunisia Turkey Turkmenistan Tuvalu Turks And Caicos Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis And Futuna West Bank Western Sahara Yemen Zambia Zimbabwe
12. Applying for (select only one and complete the rest of the application accordingly) * (Required)

    Counselor Support Staff
13. Are you a student? * (Required)

    Yes No
14. What type of student are you? * (Required) Select one Secondary School Student University Student Graduate School Student
15. Name of school * (Required)
16. Field of study * (Required)
17. Anticipated graduation date * (Required)

    Month Select month January February March April May June July August September October November December Day Select day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year Select year 2010 2011 2012 2013 2014 2015 2016 2017

Please provide us with information about your job

1. Name of current employer/company * (Required)
2. Position/Occupation * (Required)
3. Length of employment * (Required)

1. Have you ever participated in an exchange program in the U.S.? * (Required)

   Yes No
2. How many times have you participated in an exchange program in the U.S.? * (Required) Select one 1 2 3 or more

Please list all of the programs you have participated in, with the most recent program first

1. Name of camp/school/workplace * (Required)
2. Position *
3. Name of sponsoring organization * (Required)
4. Dates participated * (month/day/year)
5. Name of camp/school/workplace * (Required)
6. Position *
7. Name of sponsoring organization * (Required)
8. Dates participated * (month/day/year)
9. Name of camp/school/workplace * (Required)
10. Position *
11. Name of sponsoring organization * (Required)
12. Dates participated * (month/day/year)

Correspondence Information

Please enter the address in your home country where we should send the sponsorship paperwork.

1. Street Address * (Required)
2. City * (Required)
3. State, Province
4. Postal Code
5. Country * (Required) Select Country Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Aruba Ashmore And Cartier Islands Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Bassas Da India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic Of Cook Islands Coral Sea Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Europa Island Falkland Islands (Islas Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern And Antarctic Lands Gabon Gambia, The Gaza Strip Georgia Germany Ghana Gibraltar Glorioso Islands Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island And Mcdonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle Of Man Israel Italy Jamaica Jan Mayen Japan Jersey Jordan Juan De Nova Island Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Martinique Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Zealand Neutral Zone New Caledonia Nicaragua Niger Nigeria Niue Norfolk Island North Korea Norway Oman Pakistan Palau Panama Paracel Islands Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre And Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia And The South Sandwich Islands South Korea Spain Spratly Islands Sri Lanka Stateless Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tromelin Island Tunisia Turkey Turkmenistan Tuvalu Turks And Caicos Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis And Futuna West Bank Western Sahara Yemen Zambia Zimbabwe
6. Either a home or mobile telephone number is required.
   Phone (with country and city codes) * (Required)
7. Mobile Phone (with country and city codes) * (Required)
8. Email * (Required)

Emergency Contact (English-speaking)

1. First Name * (Required)
2. Last Name * (Required)
3. Relationship to you * (Required)
4. Street Adress * (Required)
5. City * (Required)
6. State/Province * (Required)
7. Postal Code
8. Country * (Required) Select Country Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Aruba Ashmore And Cartier Islands Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Bassas Da India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic Of Cook Islands Coral Sea Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Europa Island Falkland Islands (Islas Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern And Antarctic Lands Gabon Gambia, The Gaza Strip Georgia Germany Ghana Gibraltar Glorioso Islands Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island And Mcdonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle Of Man Israel Italy Jamaica Jan Mayen Japan Jersey Jordan Juan De Nova Island Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Martinique Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Zealand Neutral Zone New Caledonia Nicaragua Niger Nigeria Niue Norfolk Island North Korea Norway Oman Pakistan Palau Panama Paracel Islands Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre And Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia And The South Sandwich Islands South Korea Spain Spratly Islands Sri Lanka Stateless Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tromelin Island Tunisia Turkey Turkmenistan Tuvalu Turks And Caicos Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis And Futuna West Bank Western Sahara Yemen Zambia Zimbabwe
9. Phone (with country and city codes)
10. Email * (Required)

Friend/Family Contact in the United States

1. Do you have a friend or family in the U.S.?
   (If you answer yes you must enter the following information.) * (Required)

   Yes No
2. First Name * (Required)
3. Last Name * (Required)
4. Relationship to you * (Required)
5. Street Adress * (Required)
6. City * (Required)
7. State * (Required) Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
8. Postal Code * (Required)
9. Phone (with country and city codes) * (Required)
10. Email * (Required)

Medical History

1. Are you in good health? * (Required)

   Yes No
2. Height Conversion Information * (Required)

   feet inches

   To convert centimeters to inches: cm x .39 = inches 12 inches = 1 foot e.g. 180 cm x .39 = 70 inches or 5 feet, 10 inches

3. Weight (in pounds) Conversion Information * (Required) lb.

   To convert kilos to pounds: kg x 2.2 = pounds e.g. 70 kg x 2.2 = 154 pounds

4. Do you have any physical disabilities? * (Required)

   Yes No
5. If yes, please describe
6. Do you have any dietary restrictions? * (Required)

   Yes No
7. If yes, please describe
8. Have you ever or are you currently suffering from an eating disorder? * (Required)

   Yes No
9. If yes, please describe
10. Do you have any allergies or special medical requirements? * (Required)

    Yes No
11. If yes, please describe
12. Have you ever suffered from a nervous breakdown or mental disorder? * (Required)

    Yes No
13. If yes, please describe

Visa History

1. Have you ever applied for a United States visa before?
   If you answer yes you must enter the following information. * (Required)

   Yes No
2. If yes, from what country did you apply?
3. What was the final decision of the U.S. Embassy/Consulate?
4. Passport numbers

Past Experience

Please list two of your past jobs (paid or voluntary) and in 2 or 3 sentences describe how they will be relevant to your position at camp.

1. Name of Company * (Required)
2. Dates of Employment * (Required)
3. Details * (Required)

   In two or three sentences, please describe how this job or volunteer experience is relevant to your position at camp.

4. Name of Company
5. Dates of Employment
6. Details

   In two or three sentences, please describe how this job or volunteer experience is relevant to your position at camp.

Camp Placement

Please list the position you will have at camp this summer, and in 3 or 4 sentences, describe your job responsibilities and/or daily role at camp.

1. Job Description * (Required)