Date___________
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Name__________________________________________
Email address____________________________________
Permanent Address
Street___________________________________________
City_____________________ State_____ Zip_________
Phone___________________Cell____________________
Current Address
Street___________________________________________
City_____________________ State_____ Zip_________
Phone__________________________________________
SAM ID ____________________________
Birthdate______________________ age_____
Gender: Female Male
Major____________________ Minor________________
I am enrolled as a college:
 Freshman Sophomore
 Junior Senior Graduate Student
(Expected) Graduation Date _______________________
Please circle your choice of session(s):
Session 1
Session 2
Session 3
Transfer
Please describe your involvement at SHSU. (Including current organizations you belong to and activities you
participate in on and off campus.)
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Bearkat
Bearkat
Camp
Camp
Spirit • Pride • Tradition • Since 1879
BEARKAT CAMP COUNSELOR APPLICATION
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Why do feel that you would make a good Bearkat Camp Counselor?
For Office Use Only
Received:
By:
Interview:
Action:
Session:
SHSU Bearkat Camp Counselor Application
What makes you proud to be a Bearkat?
By submitting this application and furnishing your campus ID you are giving the SHSU Recreational Sports
office permission to verify your enrollment status, GPA and to view your disciplinary/student conduct record.
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What, if any, experience do you have as a camp counselor and/or camper?
Certifications Organization Expiration
Date
First Aid - _______________________ __ _________
CPR - ____________________________ _________
Lifeguarding - ______________________ _________
Water Safety Instruction_______________ _________
Others: ________________________________ _________
SHSU Faculty/Staff References (optional)
Name:__________________________________________
Phone: _
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Name:__________________________________________
Phone:_____________________________________
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Anything else you want us to know?
SHSU Bearkat Camp Counselor Application