2026 SMILE Application

2026 Camp SMILE or the Camp SMILE Teen Application

Thank you for your interest in helping us grow our Camp SMILE Teen program at the Northern Virginia 4-H Educational & Conference Center! It is because of YOU that over 1,600 youth will have an amazing experience at camp this summer.
Dear Potential SMILE Teen:

Thank you for your interest in the Camp SMILE Program at the Northern Virginia 4-H Educational and Conference Center, which sits on 229 acres in Front Royal, Virginia and has offered Junior 4-H Camp to youth in Northern Virginia for over 40 years. Our programs stress the 4-H philosophy of “learn by doing”, which means participants are actively learning during their experiences due to full engagement in the activities. This Experiential Education leads to the development of lifelong skills. The 4-H Center is a large facility, and our average weekly number of Junior 4-H Camp participants is approximately 250 youth

The SMILE Program, allows teens (graduating seniors) who are interested in becoming future summer camp staff members an opportunity to come back to camp and work as Camp SMILE teens. While SMILE teens are still responsible for nightly camper supervision and taking them from class to class, they are also given additional responsibilities. Responsibilities that may inclide helping the Summer Staff with classes, general camp duties, and programming assignments. Your experience as a SMILE Teen should enlighten you as to what life as a staff member is like, your potential for leadership development, and the joys of being a positive role model for youth. All teens who attend Camp SMILE will recieve a $100 stipend.

If you are interested in a position at the Northern Virginia 4-H Educational and Conference Center, please complete this application and required forms. If you have any questions regarding 4-H Center program employment, please call (540) 635-7171 or email Tatyana@vt.edu

Sincerely,
Tatyana “Sequoia” Yates

---------------

Tatyana Yates

Program Director

Northern Virginia 4-H Educational and Conference Center

600 4H Center Drive, Front Royal, VA 22630

tatyana@nova4h.com | (540) 635-7171 x3 | www.nova4h.com

Personal Information
Name*

First NameLast Name
Pronouns
Date of Birth*

MonthDayYear
Date
Permanent (Home) Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*

Area CodePhone Number
Home Phone

Area CodePhone Number
Email Address*
example@example.com
4-H Camping County
Dietary Restrictions

Camp Experience:

Describe camp experience or any other experience working with youth. Highlight your knowledge, skills, and abilities that best demonstrate your qualifications for this position.
1). Name of Camp:*
Date:

MonthDayYear
Date
Duties:*
2). Name of Camp:
Date:

MonthDayYear
Date
Duties:
3). Name of Camp:
Date:

MonthDayYear
Date
Duties:

License & Certifications

Include driver's license and other pertinent certifications (first aid, CPR, lifeguard, etc.)
Include: Certification Name, License or Reference Number, Expiration Date, and the Licensing Board:
(ex. CPR, #123456, exp: 8/2021, American Red Cross)
Include: Certification Name, License or Reference Number, Expiration Date, and the Licensing Board:
(ex. CPR, #123456, exp: 8/2021, American Red Cross)
Include: Certification Name, License or Reference Number, Expiration Date, and the Licensing Board:
(ex. CPR, #123456, exp: 8/2021, American Red Cross)
Include: Certification Name, License or Reference Number, Expiration Date, and the Licensing Board:
(ex. CPR, #123456, exp: 8/2021, American Red Cross)

References

Please list three references other than family members who can attest to your personality, character, and professional qualities. At least one of your references MUST be your extension agent.
1). Reference Name:*
Reference Phone:*
Reference Email:*
2). Reference Name:*
Reference Phone:*
Reference Email:*
3). Reference Name:*
Reference Phone:*
Reference Email:*
In order to complete the application process, you will need to have three references who have knowledge of your personality, character, and professional qualifications complete an online reference form.

It will be your responsibility to contact your references and provide them with the link to our online reference form https://www.jotform.com/build/251065822274152

If you are asking a current staff member or one who has been on staff within the past 2 years, this can only account for 1 of your 3 references. We ask that at least one of your references be the Extension Agent you camped with.

Camp Skills

Please list your knowledge and skills in the following areas using the following values: 1 = no interest, 2 = no experience, 3 = some knowledge/interest, 4 = can assist with activity, 5 = can instruct/lead activity
Artistic Creation*
Campfire Programs*
Challenge Course/Low Ropes*
Creative Arts/Fine Arts*
Conflict Resolution*
Emotional Intelligence*
Forestry/Nature Education*
Group Games*
Initiative/Ability to Work Independently*
Leadership Development*
Debriefing*
Medical Training*
Outdoor Living Skills/Cooking*
Paddling Sports*
Programming *
Shooting Sports*
Song Leadership*
Supervisory Skills*
Swimming*
Fitness/Health*
Science, Technology, Engineering, and Math (STEM)*
Your Soapbox...
Please tell us why you are interested in being a SIT?*
Please describe your ability to work with others and independently resolve conflicts?*
What qualities or skills do you possess that would make you the best candidate for a SIT position?*
What contributions would you bring to the camp staff?*

Certification
I hereby certify that all entries in this application are true and complete, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part to any employment in the service of the 4-H Educational Center. I understand that all information on this application is subject to verification and I consent to criminal history background checks. I also consent to references and former employers and educational institutions listed being contacted regarding this application. I further authorize the 4-H Educational Center to rely upon the use, as it seems fit, any information received from contacts. Information contained on this application may be disseminated to other agencies, nongovernmental organizations or systems on a need-to-know basis for good cause shown as determined by the center head or designee.
Signature:*

Clear
Today's Date:*

MonthDayYear
Date
Virginia Cooperative Extension programs and employment are open to all, regardless of age, color, disability, gender, gender identity, gender expression, national origin, political affiliation, race, religion, sexual orientation, genetic information, veteran status, or any other basis protected by law. An equal opportunity/affirmative action employer.

Individuals with disabilities desiring accommodations in the application process should notify Northern Virginia 4-H Educational Center at 434-248-5444 by the application deadline.
*TDD number is (800) 828-1120.
Should be Empty:

2026 Camp SMILE or the Camp SMILE Teen Application

Personal Information

Camp Experience:

License & Certifications

Miscellaneous

References

Camp Skills

Your Soapbox...

Certification