Anytown 2025 Advisor Application

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

Anytown Advisors must be at least 23 years of age. (Applicants between the ages of 23-25 may be asked to serve as Anytown Counselors.)
Throughout the week at Anytown, advisors are expected to be actively engaged by working well with other staff members, contributing positively to delegate morale, participating in small discussion groups/cabin activities and supporting daily programs.

If you were an Anytown counselor in 2024, you may be asked to wait 1-2 years before returning as an Anytown Advisor.

Please check the statements which apply to you. Remember you must attend the full week. I am applying to the following session of Anytown.

Session I: June 15-20, 2025 (arrive Friday, June 13 for on-site staff training)Session II: July 13-18, 2025 (arrive Friday, July 11 for on-site staff training)I can attend either session. (Availability for both sessions increases the likelihood that we can find a spot for you on the Anytown staff.)

Full Name

First Name

Middle Name

Last Name

Pronouns

What do you like to be called?

Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Contact

Email

Cell Phone Area Code (please include parentheses around area code ex: (336))

Cell Phone Phone Number (please put a dash between 3rd and 4th number ex: 123-4567

Additional Information

T-Shirt Size

Date of Birth

Month

Day

Year

Do you speak a language other than English? (specify)

Certifications

Please check any certifications that you may have (please specify and include expiration date):

First Aid/CPROther

Please specify certifications and include expiration date:

Employment

These answers do not impact your eligibility for the program. We just want to know more about you!

If you selected "Current student" above, please complete the following information:

School

Degree pursuing

Expected graduation date

If you selected an employment status other than "Current student" above, please complete the following information:

Place of employment or place retired from

Position

Dietary Restrictions

Do you have any food allergies or dietary restrictions? If so, please list:

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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?

Anytown is a physically and emotionally impactful (and demanding!) program. There will be topics, conversations, and/or programs that can be emotionally triggering not only for participants but also for staff. Do you feel you currently have the emotional capacity to be a part of this program? Please elaborate.

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 Kelly Dawson, kdawson@nccjtriad.org

Applicant signature

Date

Driver's License or State ID Number (list state if not from North Carolina)

Social Security or other identification number

Trainings Committment

You understand that if chosen as staff for Anytown 2025, you are expected to attend all staff training as well as ALL days of Anytown. Please place a check mark next to each training date below, for the session you are applying for, to indicate that you can attend staff training.

(If you are interested in serving on Anytown staff but are not available for all training dates, please contact Kelly Dawson at kdawson@nccjtriad.org or 336.272.0359 x 210. We may be able to accommodate your schedule depending on our demographic needs and availability. Priority will be given to applicants that are available for all training dates.)

Training Dates:

Both Sessions New Staff Training (New Advisors Only): May 14th 5:30-8:30Both Sessions All Staff Tie-Dye Party: June 4th 5:30-7:30Session 1- depart on June 13 for on-site training June 13-15Session 2- depart July 11 for on-site training July 11-13

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.

Applications must be submitted to the NCCJ office by 12:00PM Friday, February 28.

You will receive an email communication no later than Friday, March 14th with a decision regarding your application.

If you are selected to be an Anytown counselor, confirmation of your acceptance of the position must be received by NCCJ by 5:00 Friday, March 21.

If you have questions regarding this application, please contact Kelly Dawson, kdawson@nccjtriad.org or (336) 272-0359 x 210.

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Personal Information Release

I grant permission for my name, phone number, and email address to be distributed to other Anytown staff members. I do not grant permission for my name, phone number, and email address to be distributed to other Anytown staff members.

Electronic Signature

Note: Staff contact information will not be distributed to delegates.

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Photo Release

I understand that I, alone or with other participants and/or NCCJ staff, volunteers or representatives, may be interviewed, photographed, recorded on film, audio tape, or other visual and sound computerized, telephonic, voice-mail or tape media ("photographs and/or sound/image recordings") and/or may provide written or oral statements to NCCJ and/or others approved by NCCJ.

I hereby consent to the foregoing and grant permission, without reservation, to NCCJ and/or those approved by NCCJ to generate, prepare, advertise, describe and/or publicize NCCJ and its work, good will, public education and/or fundraising activities, disseminate, otherwise use and comment upon the photographs and/or sound/image recordings as they may determine, without review by me and without financial or other obligation of any nature to me.

I consent that I may be identified by name, age or otherwise, as NCCJ and/or those approved by NCCJ may determine.

I release NCCJ, its officers, Board members, volunteers, agents, employees and licensees from all claims that I may have, or might have, for any cause of action arising out of the taking and/or use of the photographs and/or sound/ image recordings as set forth herein.

This consent and release shall continue in effect, without a limitation of time.

I do consent and agree to the photo release terms mentioned above. I do not consent and agree to the photo release terms mentioned above.

Electronic Signature

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Anytown Code of Ethics

I accept my appointment to the 2025 Anytown Staff. I recognize that this appointment is an honor, and I understand my responsibility to myself, to NCCJ, to my fellow staff members, and to the delegates, and therefore, will put my best self forward. I will follow and enforce all of the guidelines of ANYTOWN. I agree to:

Be present and on time for all activities during the entire week of ANYTOWN
Treat all Anytown staff and delegates equally and with respect
Obey the law in all aspects of the Anytown program with all parties involved (staff, delegates, etc.). This includes no D.A.W.G.S.S. (drugs, alcohol, weapons, gambling, smoking or sexual activity), no use, unreported witnessing or supply of illegal substances at and after Anytown, or any other activities that may violate Anytown norms or are considered criminal acts under state/federal laws.
Report to the NCCJ Staff if I see any violations of D.A.W.G.S.S.
Refrain from using cell phones, other communication devices, headphones, hand-held electronic games, etc., outside of staff quarters.
Avoid being alone with minors in secluded areas or any situations that could be considered a violation of professional guidelines
Maintain confidentiality at and after Anytown with delegates as well as staff, (except for mandatory reporting).
Have no physical (sexual/romantic) relationships with delegates (under the age of 18) at or after Anytown.
Avoid criticizing other staff members or the program, especially when delegates are present.
Exhibit language and behavior that is consistent with the ideals of Anytown.
Be prepared for discussion cabin group conversations and workshops by studying materials in advance.
Maintain that delegates' Anytown experience is most important and supersedes my own needs.
Staff members are prohibited from making use of or reproducing NCCJ’s curricula or supplementary material for any purpose other than rendering service to NCCJ.
HAVE FUN AND SPREAD 'THE ANYTOWN SPIRIT!'

Electronic Signature

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Anytown Bullying Policy

At Anytown, we have a firm policy against all types of bullying. Everyone in the program is expected to treat each other with respect. This includes delegates (campers), volunteers, and NCCJ staff members. Our Anytown staff has been trained to recognize all incidents of bullying and take them seriously. We promote respectful communication between staff and delegates and work together as a team to ensure that each delegate has a wonderful and safe experience at Anytown.

What is Bullying?

Bullying is aggressive behavior that is intentional, is repeated over time, and involves an imbalance of power or strength. Bullying can take on various forms, including:

Physical bullying – when one person engages in physical force against another person, such as by hitting, punching, pushing, kicking, pinching, or restraining another.
Verbal bullying – when someone uses their words to hurt another, such as by belittling or calling another a hurtful name.
Nonverbal or relational bullying – when one person manipulates a relationship or desired relationship to harm another person. This can include social exclusion, friendship manipulation, or gossip. This type of bullying also includes intimidating another person by using gestures.
Hazing – an activity expected of someone joining or participating in a group that humiliates, degrades, abuses, or endangers that person regardless of that person’s willingness to participate.
Sexualized bullying – when bullying involves behaviors that are sexual in nature. Examples of sexualized bullying behaviors include sexting, bullying that involves exposures of private body parts, and verbal bullying involving sexualized language or innuendos.

Anyone who sees an act of bullying, and/or who then encourages it, is engaging in bullying. This policy applies to all employees, contractors, and volunteers.

Bullying may show up as:

Teasing
Name calling
Excluding others
Rumors
Ganging up
Intentionally disrupting programs and activities
Mocking or taunting

What’s the Impact?

The bullying behavior has a negative impact emotionally, spiritually, or physically on the target/victim.

Discipline Procedures

If a delegate does not follow Anytown’s community agreements, we will take the following action steps as behavior problems progress:

Staff will redirect the delegate to more appropriate behavior.
If inappropriate behavior continues, the delegate will be reminded of the first warning they received. NCCJ staff will work with the student to decide on appropriate action steps. A phone call home may occur at this point if staff and/or student feel like this is necessary or could be helpful.
If a delegate’s behavior continues the delegate’s guardians will be notified, or the delegate may be dismissed from camp.

*Bullying incidents and action steps will be documented by NCCJ staff.

If a delegate is participating in bullying activities, the delegate’s parent or guardian can be called and asked to come and pick up their child immediately, regardless of the time of day or day of the week.

If a delegate, volunteer, or parent has questions or concerns about bullying, they are encouraged to reach out to NCCJ Staff or Anytown volunteer staff.

By signing below I acknowledge that I have read, understood, and agree to the bullying policy above.

Electronic Signature