2024-2025 Fellows DC Application

LearnServe International Fellows Student Application 2024-2025

Thank you for your interest in the LearnServe International Fellows Program. Please complete the following application to be considered for the Program. All required fields must be completed.

Once you have submitted your application, the LearnServe team will follow up regarding next steps in the application process, including an interview. For any additional questions, please contact Eva Newbold at eva@learn-serve.org.

Demographic Information

I am a *

First Name *

Last Name *

Date of Birth mm/dd/yyyy *

Your Email *

Cell Phone *

Do you have a permanent address? *

Yes

No

Street Address (If no permanent address, put N/A) *

City *

State *

Zip Code (If no permanent address, put 0) *

Ward/County

I am currently a: *

If you are enrolled in school, what is your school type *

What school do you attend? *

High school graduation year: *

Please specify the gender you most identify with at this time: *

Pronouns *

What is your race/ethnicity? Check all that apply *

What is the language most often spoken in your home? *

Do you receive Medicaid benefits? *

Do you receive free lunch? *

Parent/Guardian Information

Parent/Guardian 1 First Name *

Parent/Guardian 1 Last Name *

Parent/Guardian 1 Email *

Parent/Guardian 1 Cell Phone *

Parent/Guardian 1 Home Phone

Parent/Guardian 1 Work Phone

Parent/Guardian 1 Relationship *

Parent/Guardian 1 Same address as you? *

Yes

No

Parent/Guardian 1 Address (if different from yours)

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Email

Parent/Guardian 2 Cell Phone

Parent/Guardian 2 Home Phone

Parent/Guardian 2 Work Phone

Parent/Guardian 2 Relationship to you

Parent/Guardian 2 Same address as you?

Yes

No

Parent/Guardian 2 Address (if different from yours)

Reflection Questions: 2-3 sentences will suffice for each question.

What is something that you have accomplished this year that you are proud of and why? *

What improvements would you like to see in your school or community, and why? *

Describe a time when you overcame a challenge or obstacle, and how? *

Additional Questions

We will have three different session times for programming this fall. Please indicate your preferred session time below. Please note, even for the virtual option, the expectation is that you attend some events in person throughout the year. (Check all that apply.) *

Thursdays, 4:30-6:30 (In-Person)

Thursdays, 4:30-6:30 (Spanish, In-Person)

Thursdays, 5:30-7:30 (Virtual)

I do not have a preference

Will you be able to fit this commitment in with your other school and home responsibilities? *

I have access to the following: (Check all that apply) *

Internet

Zoom

Google Docs

All of the Above

I have talked to my parent(s)/guardian(s) about applying to the LearnServe Fellowship program. *

How did you find out about the LearnServe Fellows Program? *

If other, please explain.