Camp Host Application Form

1

Full Name:* This field is required.

First Name

Middle Name

Last Name

2

Camp Name:* This field is required.

3

Parent/Corporate Company Name:If applicable

4

Camp Site Address:* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

5

Contact Name:* This field is required.

First Name

Last Name

6

Contact Title:* This field is required.

7

Contact Phone Number:* This field is required.

Area Code

Phone Number

8

Contact Email:* This field is required.

example@example.com

9

Website:*If applicable

10

Number of Full-Time Domestic Employees:* This field is required.At your location, not including other offices.

11

Federal Employer Identification Number (FEIN):* This field is required.

12

Worker’s Compensation Insurance Provider:* This field is required.

13

Worker's Compensation Policy Number:* This field is required.

14

Is Your Camp A Member Of The American Camp Association?* This field is required.

YESNO

15

Is Your Camp Accredited By Any Formal Entity Or Organization?* This field is required.

YESNO

16

What Accrediting Body: * This field is required.

17

Is Your Camp Officially Affiliated With A Nationally Recognized Non-profit Organization?* This field is required.

YESNO

18

What Is The Name Of The Organization: * This field is required.

19

Have You Hosted J-1 Exchange Visitors In The Past?* This field is required.

YESNO

20

Please Check The Program Type Below:* This field is required.

J-1 Camp Counselor

J-1 Work and Travel