UW Oshkosh


USA Summer Camp Application

First Name
Last Name
UW Oshkosh Student ID (if applicable)
Academic Year Address (house #, street, apartment #)
Academic Year Address (city, state, zip)
Academic Year Phone
Summer/Break Address (house #, street, apartment #)
Summer/Break Address (city, state, zip)
Summer/Break Phone
UW Oshkosh Email Address ONLY:
Birth date
Male  Female
I am a
U.S. Citizen  Permanent Resident  Citizen of
I am a
freshman Sophomore Junior
Senior Graduate student    not a student
I attend (school name)
Cumulative GPA to date
Expected Graduation Date
Have you ever been convicted of a felony?
Yes      No
If yes, explain:
If you have a passport, complete the following
My name, exactly as it appears on my passport, is
Passport Expiration Date
Passport Number
Passport Issue Office

If selected, I understand that I will be assigned a camp location and dates during which I must be in Japan. I understand that in order to be eligible for this program, I must be available between July 1 and the third Saturday in August, though my actual placement in Japan may be for a shorter period of time.

I have no conflicts with the program dates.
I have conflicts on the following dates:

Type your answers to the following questions. Answers may be elaborate or concise and will be used by the interview team to select applicants for interviews. If selected, your answers will also be shared with camp administrators in Japan and will be considered when offering positions. Your answers should let us know that you will make a good camp counselor in Japan and that you understand USA Summer Camp's program goals.

Why would you like to participate on this program?

What expectations do you have of this program as a whole, the pre-travel family orientation, your host family, Guy Healy, Japan, other counselors (Japanese and American) etc.?

Language/Cultural Skills:
Have you studied a foreign language (not necessarily Japanese)? If so, what is your level of fluency?
Have you completed any University level courses on the culture or history of Japan? If so, explain.
Have you ever been immersed in a language and/or culture abroad? If so, please explain.
Do you plan to use a foreign language in a professional setting? If yes, please explain.

Have you traveled abroad? If so, list the places to which you have traveled along with the dates and purpose.

Have you developed any skills through working with, teaching, assisting or training kids/students age kindergarten through college which you feel will be useful at USA Summer Camp? If so, please elaborate. Also, list and describe responsibilities you've had at work, in school or at home which would be relevant to your application to USA Summer Camp. Information here should be supported by recommendation/s from your direct supervisor/s and/or by a list of references (including name, title and phone number).

What are your hobbies and interests?

What do you expect to gain from your experience at USA Summer Camp?

Additional comments in support of your application

Choose all group interview dates during which you are available; you will be scheduled on the first available date on a first-come, first-served basis. If you choose only one date/time and that interview time has already filled, you will be placed on a waiting list to interview.

Tuesday, September 13, 2016 from 3:00-4:00 PM (Dempsey 202)
Thursday, October 20, 2016from 3:00-4:00 PM (Dempsey 202)
Monday, December 5, 2016 from 3:00-4:00 PM (Dempsey 202)

I certify that the information stated above is true and correct. I understand that falsifying or withholding information on this application may be cause for dismissal from camp and return to the U.S. at my own expense. If accepted to the program, I agree to regularly check my university email account for program information and updates from Guy Healy, Japan.

I understand that my application is not complete when I submit this form electronically. I understand the application requirements and will follow up by returning the necessary forms to the Office of International Education in Dempsey 202 and by completing all other application requirements by the application deadline.




This page was last updated on: July 14, 2015




September 1, 2016