LearnServe Fellows Program Application 2012-13
Thank you for your interest in the LearnServe Fellows Program!  Applications must be received by April 30, 2012.  All required fields must be completed!

Applicants will be contacted for phone interviews in May.  Students accepted into the LearnServe Fellows Program will be notified in early June.  Accepted students will be asked to pay a $100 enrollment fee.  Financial assistance is available to any student who needs it, and no one will be turned away for inability to pay.

Before submitting your application, please let your school's LearnServe Advisor know that you are applying for the 2012-13 LearnServe Fellows Program, and please ask your advisor about any additional steps to the application process required by your school.

Questions?  Contact Scott at fellows@learn-serve.org.
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Applicant Information
First Name *
Last Name *
Email Address *
Cell Phone *
If applicable
Home Phone *
Street Address *
City *
State *
Zip *
County or Ward *
Year of Birth *
Class of *
Gender *
Required
Ethnicity *
Select all that apply
Required
I receive free or reduced-cost lunch at school *
Required
I receive Medicaid *
Required
First Name of Parent / Guardian 1 *
Last Name of Parent / Guardian 1 *
Relationship of Parent / Guardian 1 to you *
Home Phone of Parent / Guardian 1 *
Cell Phone of Parent / Guardian 1 *
Work Phone of Parent / Guardian 1 *
Email of Parent / Guardian 1 *
First Name of Parent / Guardian 2
Last Name of Parent / Guardian 2
Relationship of Parent / Guardian 2 to you
Home Phone of Parent / Guardian 2
Cell Phone of Parent / Guardian 2
Work Phone of Parent / Guardian 2
Email of Parent / Guardian 2
Alternate Parent / Guardian Address
If a Parent / Guardian address is not your home address, please share it here (specify which Parent / Guardian, their Name, and Mailing Address.)
I have talked with my Parent(s) / Guardian(s) about applying to the LearnServe Fellows Program *
Required
School Information
School Name *
My School Is *
Required
Name of Principal *
Name of Nominating Teacher / LearnServe Advisor *
Email of Nominating Teacher / LearnServe Advisor *
Phone of Nominating Teacher / LearnServe Advisor *
Name of one additional Reference *
A teacher other than your LearnServe Advisor who knows you well.
Email address for this Reference *
Application Questions
Please answer the following questions in detail.
Work Experience *
Describe your work experience and home responsibilities, if any.
School and Community Involvement *
Describe how you are involved in your school life, and/or in any community organizations.  Any leadership roles?
Talents, Hobbies, and Interests *
Describe your talents, hobbies, and/or interests.
What is an issue or cause you are passionate about, and why? *
Please describe this in detail.
What would you like to see improved at your school, and why? *
Please describe this in detail.
What is one accomplishment you are proud of and why? *
Travel to meetings *
Has your Parent or Guardian seen and approved of the program details?  Are you able to attend Thursday afternoon meetings (beginning at 4:30pm) throughout the school year, at Metro-accessible locations in downtown DC -- usually at the School Without Walls in Foggy Botton?  Please explain.
Commitment *
The LearnServe Fellows Program is not just an extracurricular activity.  It is an intensive training program that requires a commitment of time and work.  This includes meetings 2-3 times per month from September through May, with 1 overnight weekend retreat, 2 Saturday retreats, online discussions, and the development and implementation of an action project in your school.  Also, Fellows will be responsible for paying a $100 enrollment fee (waived for students requesting financial assistance), and may have other school-based fundraising requirements.  Given your understanding of these responsibilities, how can you balance this commitment with your other responsibilities?
What do you hope to learn from and what will you be able to offer the LearnServe Fellows Program? *
How did you learn about the LearnServe Fellows Program? *
Required
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