X/TwitterThis field is for validation purposes and should be left unchanged.Please fill out this form if you've received confirmation that you've been accepted as a member of program staff this year. We need this information to 1, confirm your place in the program and 2, finalize program logistics with program leaders! Please contact us at connect@npines.org if you have any questions.Please note, if you leave or refresh this page before successfully submitting the form, your progress will not be saved. To avoid losing your work, you can write the longer answers in a notes or document application and then copy and paste into the form fields.Section One: Your InformationName(Required) First Last Nickname or Preferred NameFor initial communication, our system will use your first name, but it is helpful to know if you go by a nickname.Week 1 Program(Required) Not serving Week 1 Children's Program The Wilderness Junior High Senior High CCA Program I'm not sure / haven't recieved placement Other Week 2 Program(Required) Not serving Week 2 Children's Program The Wilderness Junior High Senior High CCA Program I'm not sure / haven't recieved placement Other Is this your first time on staff for Northern Pines?(Required) Yes No One-way MileageDistance from home to Green Lake Conference CenterEmail(Required) Enter Email Confirm Email Mailing Address(Required) My address has not changed since I applied My address has changed since I applied I don't remember which address I use for my application Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Section 2: ScreeningDo you agree to be present for all staff development activities?(Required)Staff training starts on the afternoon of the Saturday before camp. Yes No Please explain your expected absence from staff training(Required)Statement of Faith(Required)Do you agree with the position of Northern Pines on this matter (Statement of Faith), and, that as a member of the staff, you will uphold it in word and action? Read our Statement of Faith here Yes No Standards of Behavior(Required)Do you agree with the position of Northern Pines on this matter (Standards of Behavior), and, that as a member of the staff, you will uphold it in word and action? Read our Standards of Behavior here Yes No Have you ever been convicted or pleaded guilty to a crime?(Required) Yes No If yes to convicted or plead guilty to a crime, please explain(Required)Any additional comments?Section Three: Meals, Transportation, & Weekend LogisticsFor more information on the special meal requests, transportation, and transition weekend, please visit the parent portal at npines.org/parent-portalDietary Needs(Required)Special dietary meals are available for an additional $50 per person, per week. If you need a special meal (Gluten-free, dairy-free, etc.), please submit the special dietary request form I will not need special dietary meals I will need special dietary meals and already submitted that form I will need special dietary meals but have not submitted that form yet Transportation to/from GLCC(Required) I am driving myself I am riding with someone else I don't know yet Transition Weekend(Required)There is no charge for Program Staff to stay at GLCC for the Transition Weekend (Saturday and Sunday between Week 1 and Week 2) if they are also serving week 2. Food and lodging are provided. I will stay on campus for the transition weekend I will not be on campus for the transition weekend and will not need lodging or meals for Saturday (lunch & dinner) or Sunday (breakfast & lunch) CAPTCHA
