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Counselor Application
Your Name:
Your Email:
Your Location (City, State) or (City, Country):
Your Date of Birth (MM/DD/YYYY):
Your Gender:
Your Sexuality:
Why do you feel you are qualified to be a counselor?
Write the age and describe your relationships with those you live with:
Write the age and describe your relationships with the two people you feel closest to (who are not included above):
Write about grades and interest in school, work or volunteer experience, extracurriculars, and hobbies. (Quality over quantity in most cases):
What has been your exposure to tobacco, drugs, and alcohol? (Personal use, friends, family, etc.):
Describe a time when you overcame an obstacle or adversity. (If you have overcome serious depression or abuse, please discuss these in particular.):
Write a brief paragraph to be placed in the counselor section: