Counselor Application - Anytown 2024

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Thank you for your interest in being on staff at Anytown!

Throughout the week at Anytown, counselors are expected to be actively engaged by working well with other staff members, teaching songs, planning skits, contributing positively to delegate morale, leading small discussion groups and supporting daily programs.

Full Name



Additional Information

ex: 19

Date of Birth

Demographic Information
To ensure diversity at Anytown, we ask that you please check any / all of the following that apply to you. (This information is confidential and will be viewed by NCCJ staff only. It will not be used or disclosed for any other purposes.)

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COVID-19 Information

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.

Please give the name, email address and phone number of at least one individual (not a relative) who has known you for one year or more.


Open-Ended Reflection Questions

Training Dates Commitment
You understand that if chosen as staff for Anytown 2024, 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 2024 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 2024 staff may be removed from staff, even days before leaving for Anytown.

By signing below, you consent to a criminal background check(s).  If there is an issue with this, please contact Kelly Dawson,

Parent/Guardian Signature (if applicant is under 18):

By signing below, I give my permission for the young person named above to apply as a Counselor for the NCCJ of the Piedmont Triad Anytown 2024 residential program. I also give my consent for NCCJ to perform a background check on the young person named above.

Application Process Timeline

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

Applications must be submitted to the NCCJ office by 9:00am, Monday, March 4th, 2024.

You will receive an email communication no later than Friday, April 5th 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 counselor, confirmation of your acceptance of the position must be received by NCCJ by 5:00pm, Friday, April 12th, 2024.

If you have questions regarding this application, please contact Kelly Dawson, or (336) 272-0359.