COUNSELOR APPLICATION

WHAT: The Pilipino Youth Conference (PYC) is a three-day event filled with workshops,
organizational and leadership development activities, social activities, college information,
and cultural and artistic empowerment to encourage youth to pursue higher education.

MISSION: The Pilipino Youth Conference is used to help high school students open their
minds, discover their potential, and become empowered through learning about their
heritage, cultural identity, and potential power in society. The purpose of the retreat is to give
students information dealing with personal issues (such as identity, sexuality, leadership, and
activism), social issues (such as womyn history and immigrant experiences), and tips to
receive higher education through college. The retreat will be focused on issues related to
and facing today’s Filipino-American youth. However, you do not have to be Filipino to attend!

WHO: BRIDGE of UC Davis will be hosting the Pilipino Youth Conference. BRIDGE is a
Filipino based outreach and retention program. We focus on higher education and activism
for high school and college students. Any high school student is welcome to attend and those
interested in activism, higher education, and Filipino/a culture.
You DO NOT need to be Filipino to attend!!

WHEN: Friday, January 22 through Sunday, January 24, 2010. (It will be an overnight!)

WHERE: UC Davis

DUE: DECEMBER 12, 2009 at 11:59PM!

Acceptance Packages will go out by December 20 and will have information on:
• Training Retreat • Schedule • Directions • Workshop Summaries • Counselor Partners •

MAIL TO: Nicole Tomboc

E-MAIL: pycretreat2010@gmail.com
ADDRESS: 813 Zaragoza Street Davis, CA 95616
PHONE: (408) 219-1770
FAX: (530) 752-3257 (ATTN: Nicole Tomboc)
(It is preferred that you e-mail your applications.)

Please keep in mind that the counselor applications are read thoroughly with the best intentions of the
students in mind. Please do your best to fully express yourself on this application. If you are not
selected to be a counselor, we highly encourage you to volunteer for the event!

Counselor Application
 APPLICATIONS ARE DUE DECEMBER 12, 2009.

PYC Retreat 2009, January 22-24, 2010 at UC Davis

Please complete this form carefully. Please type or print neatly. Use additional paper and attach if you are
sending through mail and not by e-mail.

First Name:
Last Name:
Preferred Name (if different from first name):
Date of Birth:
Gender: Male Female Decline to State
T-Shirt Size: Small (S) Medium (M) Large (L) X-Large (XL)
Current Address:
City: State: Zip Code:
Phone Number:
E-mail Address:
Emergency Contact Name:
Phone Number:
School Name (if currently enrolled):
Dates Attended:
Major and/or Minor:

Do you have any dietary considerations? If so, what are they?

Counselor Training will be an overnight retreat from January 9-10, 2010. Both days are
MANDATORY.
Will you be able to attend?

Yes No

If there are any EXTREME circumstances that prevent you from attending please write
here:

Have you had a background check within the last year?

Yes No

PERSONAL QUESTIONNAIRE…
JUST TO GET TO KNOW YOU
(You may attach your answers on a separate page)
If you have any questions or concerns, please contact Nicole Tomboc:
EMAIL: pycretreat2010@gmail.com, or
PHONE: (408) 219-1770
APPLICATIONS ARE DUE DECEMBER 12, 2008.
 APPLICATIONS ARE DUE DECEMBER 12, 2009.

1. What motivates you to be a Counselor for this retreat?

2. Check all that applies to your Personality (This portion is used so that we may
match you with a partner).
Creative Shy
Outgoing Humorous
Sarcastic Passionate
Assertive Talkative
Listener Serious
Reserved Spontaneous
Laid Back OTHER:

3. Name two qualities you possess and two qualities you can improve on

4. List any community experience and explain in some way how this has shaped and
impacted you.
(Fil-Am, Theater, Community Service, High School, etc.)

5. List your Hobbies, Interests, and Passions.

6. Name an important issue you believe Pilipino Youth deal with and why?

7. What is an accomplishment you are proud of? Why?

If you have any questions or concerns, please contact Nicole Tomboc:

EMAIL: pycretreat2010@gmail.com, or
PHONE: (408) 219-1770
APPLICATIONS ARE DUE DECEMBER 12, 2008.
 APPLICATIONS ARE DUE DECEMBER 12, 2009.

ESSAY: If you could time travel back in time to your high school years, write about the
experiences that have lead you to the person you are today in 2009. Reflect on these
past experiences and talk about who you were then and who you are now.

If you have any questions or concerns, please contact Nicole Tomboc:

EMAIL: pycretreat2010@gmail.com, or
PHONE: (408) 219-1770
APPLICATIONS ARE DUE DECEMBER 12, 2008.