Leadership Development Application I 1GENERAL INFORMATION2EDUCATION3CHURCH AFFILIATION4ACTIVITIES5QUESTIONS6SKILLS CHECKLIST7REFERENCES & ACKNOWLEDGEMENTS Applicant:* First Last Date of Application* MM slash DD slash YYYY Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone:*Email:* Birthdate* MM slash DD slash YYYY LDP Session*Select One LDP I and II - Session 1: June 11-July 1 is full LDP I and II - Session 2: July 2-July 22 EDUCATIONSchool Attended*Please list the school, city, state, major subjects, dates attended and degree.Highest level completed by June 1, of this year?*Honors received (academic or other)* CHURCH AFFILIATIONDenomination*Place of Worship*City*State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificActive Member?* Yes No How long?* ACTIVITIESName and brief description of School-Related, Church, and Community Activities* PLEASE ANSWER THE FOLLOWING QUESTIONS1. Why do you want to be a LDP at Mo-Ranch Summer Camps?*2. What special contribution(s) can you make to the program?*3. What do you want to learn from this summer?*4. If you could teach one thing this summer, what would it be?* SKILLS CHECKLIST Please rate your degree of skill on the checklist below. Add comments or detail if you have particular skills in an area. Rank according to the following criteria: 1 = Experienced leading/teaching skill 2 = Experienced in skill 3 = Some experience in skill 4 = No experience in skill LeadershipActivitiesBible Study*1234Initiative Games*1234Small Group Leader*1234Low Ropes*1234Worship Planning*1234High Ropes*1234Event Planning*1234Rock Climbing*1234OtherOther Wilderness SkillsAquaticsCamping*1234Swimming*1234LNT Ethics*1234Canoeing*1234Backcountry Cooking*1234Kayaking*1234Campfire Stories*1234Fishing*1234Fire Building*1234Water Games*1234Environmental Ed.*1234OtherOther Health & SafetyArtsFirst Aid**1234Drama*1234CPR**1234Dance*1234Lifeguard**1234Singing*1234Instrument*1234Photography*1234OtherOther SportsCraftsBasketball*1234Drawing*1234Tennis*1234Painting*1234Baseball*1234Pottery*1234Softball*1234Tie Dye*1234Soccer*1234Candle Making*1234Disc Golf*1234Leather Crafts*1234Archery*1234Nature Crafts*1234OtherOther ScienceLanguagesInsects*1234Spanish*1234Animals*1234French*1234Plants*1234OtherGeology*1234 MiscellaneousAstronomy*1234Working with Children*1234Meteorology*1234Conflict Resolution*1234OtherOtherSummer camp counselors are required to hold certifications in first aid, CPR and lifeguard. LDPs may receive these certifications additionally as part of their training. REFERENCES & ACKNOWLEDGEMENTSReferences Three completed letters of recommendation must be returned directly to Mo-Ranch Summer Camps by February 1, of this year. Your references may include your pastor or youth minister, coach, teacher, or anyone of your choice (except a family member) who knows you and can assess your abilities. You may also request a letter from a previous staff member of your choice, if you have been a camper at Mo-Ranch in the past (or another camp that you enjoyed). Applicant Certification*I certify that all information given herein is true to the best of my knowledge. In the event of acceptance into the Leadership Development Program, I understand that false or misleading information given in my application or interview(s) may result in immediate dismissal. I also understand that I am required to abide by all policies, rules and regulations of Mo-Ranch Presbyterian Assembly and Mo-Ranch Summer Camps. I agree Name (Applicant Signature)*By typing your name, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.Date* MM slash DD slash YYYY Parent/Guardian Acknowledgment*Scroll and read entire acknowledgementI, the parent/legal guardian of the applicant, understand and agree that: 1. My son/daughter has discussed with me his/her intent to apply for the Leadership Development Program (LDP) at Mo-Ranch Summer Camps, and 2. Permission is hereby granted for him/her to apply for the Leadership Development Program, and 3. Presbyterian Mo-Ranch Assembly may verify any information contained in this application. I release from liability any person giving or receiving any information requested by Mo-Ranch. I understand that unfavorable information or misrepresentation discovered as a result of this investigation my prevent my son/daughter from being accepted into the LDP program 4. I will encourage and support my son/daughter to participate fully in the Leadership Development Program, and 5. My son/daughter is – to the best of my knowledge – physically, mentally, spiritually, and socially able to fully participate in all aspects of the program. 6. I understand that space is limited in each session and my child may or may not be able to attend the session they desire. Final placement of LDP sessions will be determined by the camp director. I Agree Parent/Guardian Name (Parent/Guardian Signature)*By typing your name, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.Date* MM slash DD slash YYYY Mo-Ranch Summer Camps provides campers the opportunity to grow in their faith by experiencing the love of God through relationships grounded in Christian faith, living in a community and playing and learning in our beautiful outdoor setting.CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
