Advisor Application - Anytown 2023

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COVID-19 Information

Have you been fully vaccinated against COVID-19?

YesNoPrefer not to say

We are not requiring vaccinations for staff members, however we will be attentive to any precautions and safety measures suggested by the CDC for when we go to Anytown.

I acknowledge and confirm that all information provided in the COVID-19 section of this application is true and complete to the best of my knowledge and agree to comply with all COVID-related requirements for Anytown.

Applicant Signature

Date

References

Please provide the name, email address and phone number of a reference that we may contact as part of the selection process.

Reference First Name

Reference Last Name

Reference Area Code

Reference Phone Number

Reference Email

Relationship

Ex: Teacher, Supervisor, Faith Leader

Open-Ended Reflection Questions

Why do you think programs like Anytown are important in our community?

What special skills or knowledge (besides being previously on Anytown staff if that's the case) would you bring to the Anytown program?

For experienced advisors, what challenges have you been faced with on the mountain and how did you overcome them or seek support?

For new advisors, describe a time you experience a challenge while working with a group and how you overcome it or seek support?

How did you hear about Anytown? If someone referred you, please list their name.

Disclosure

By signing below, you consent to a criminal background check(s). If there is an issue with this, please contact María Perdomo at mperdomo@nccjtriad.org

Applicant signature

Date

Social Security or other identification number

Trainings Committment

You understand that if chosen as staff for Anytown 2023, you must attend staff training as well as ALL days of Anytown. All training dates are mandatory. If you cannot commit to the training dates, please do not submit your application. Training sessions are to ensure that Anytown will be the best Anytown for the 2023 delegates; without adequate training we are unable to provide that experience.

Please place a check mark next to each training date for the session you are applying for below. By checking each individual training date box you are confirming that you are able to attend and you've tentatively held the date on your calendar.

Note: Staff members that miss a training after being accepted on Anytown 2023 staff may be removed from staff, even days before leaving for Anytown.

Training Dates:

New Advisor Orientation (both sessions) - May 17th, 5:30-8:30pmSession I: All-Staff Training - June 14th, 5:30-8:30pmSession II: All-Staff Training - July 12th, 5:30-8:30pmI confirm that I can depart the Friday before the session of Anytown I am applying to for staff training on the mountain.

Please initial here to indicate you can attend all trainings you have checked above.

Anytown Week-Of Time Commitment

Please explain here if you will be working or engaging in other activities while on the mountain. (ex: work-related meetings or a summer class.)

If something comes up before you hear back about your Anytown decision, please let us know as soon as possible.

As part of the application process, applicants may be contacted to schedule an interview with a member of the NCCJ Program Staff. If geographic locations prevents an applicant from coming to our office, the program department will schedule a phone/video interview.

Application Process Timeline:

Applications must be submitted to the NCCJ office by 9:00am, Monday, March 6th, 2023.

You will receive an email communication no later than Friday, April 7th by 5:00pm with a decision regarding your application. (Accepted, waitlisted, or asked to apply again next year.)

If you are selected to be an Anytown advisor, confirmation of your acceptance of the position must be received by NCCJ by 5:00pm, Monday, April 21st, 2023.

If you have questions regarding this application, please contact María Perdomo at mperdomo@nccjtriad.org or (336) 272-0359.

Advisor Application - Anytown 2023

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Date of Birth

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