Camp Galilee Counselor Training 
Applicant Reference Form

Applicant’s Name:_____________________________________________

Reference Name:______________________________________________

Home Phone:  (______)____________________ Work Phone:  (______)___________________

Relationship to Applicant:_________________________________________________________

The above named applicant is applying to become a counselor at Camp Galilee. The first step in becoming a counselor is being approved to attend our intensive 6 day training program. Upon being accepted for and successfully completing the training program, the applicant is then assigned to counsel specific sessions during the summer.  We seek applicants with an above average level of maturity and self-confidence.  The training program deals with topics such as conflict management, group leadership and planning, program implementation and evaluation. Participants must also be able to actively give and receive constructive feedback. This reference is strictly confidential and will not be seen by the applicant,--so please be honest in your responses.  Thank you!

Please describe the nature and length of your relationship to the applicant.

Using the following scale, please rate the applicant:
				      Excellent	         Good	          Fair	          Poor
	ADAPTABILITY		[ ]		[ ]		[ ]		[ ]
	RESPONSIBILITY		[ ]		[ ]		[ ]		[ ]
	RESOURCEFULNESS	[ ]		[ ]		[ ]		[ ]
	ENTHUSIASM		[ ]		[ ]		[ ]		[ ]
	LEADERSHIP			[ ]		[ ]		[ ]		[ ]
	SENSE OF HUMOR		[ ]		[ ]		[ ]		[ ]
	PATIENCE			[ ]		[ ]		[ ]		[ ]
	COOPERATION		[ ] 		[ ]		[ ]		[ ]
	INITIATIVE			[ ]		[ ]		[ ]		[ ]

As a counselor, the applicant would be one of the providers of care and nurturing for a group of 5-8 boys or girls 22 hours a day for a week at a time, and would be responsible to help plan and lead a group of 13 boys and girls in an adventure group. They would work closely with a resident staff person, age range from 19-25. What strengths and weaknesses do you see the applicant having in this position?

	
How would you feel about the applicant being responsible for caring and nurturing your own child?

	

Have you ever seen any behavior from the applicant that would lead you to believe they might misuse their position?

Any other comments you would like to share?

Thank you for taking the time to complete and return this form.

__________________________________________________	_______________________
Signature								Date

Return to:
galileetahoe@gmail.com (scanned) or mail to:
Camp Galilee
Counselor Training Application Reference
PO Box 236
Glenbrook, NV  89413