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 *
New Applicant
LearnServe Alum
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 *
District of Columbia
Maryland
Virginia
Zip Code (If no permanent address, put 0) *
Ward/County
Ward 1
Ward 2
Ward 3
Ward 4
Ward 5
Ward 6
Ward 7
Ward 8
Alexandria, VA
Arlington County, VA
Fairfax County, VA
Montgomery County, MD
Prince George's County, MD
I don't know
I don't live in DC
I am currently a: *
High School Student
College/University Student
An Employed Youth
An Unemployed Youth
If you are enrolled in school, what is your school type *
Public School
Charter School
Independent/Private School
Home School
N/A
What school do you attend? *
High school graduation year: *
Please specify the gender you most identify with at this time: *
Female/Girl/Woman
Male/Boy/Man
Non-binary/Genderqueer/Gender-nonconforming
I prefer not to say
Other
Pronouns *
She/Her/Hers
He/Him/His
They/Them/Theirs
Ze/Zir
Other
I don't know yet.
I prefer not to say.
What is your race/ethnicity? Check all that apply *
African Asian Black or African American Hispanic/Latino White American Indian or Alaska Native Native Hawaiian or Other Pacific Islander Middle Eastern Mixed Other
What is the language most often spoken in your home? *
Do you receive Medicaid benefits? *
Yes
No
I don't know
N/A
Do you receive free lunch? *
Yes
No
I don't know
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 *
Mother Father Step-mother Step-father Grandmother Grandfather Aunt Uncle Sister Brother Foster parent Guardian Significant Other Husband Wife Friend Other
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
Mother Father Step-mother Step-father Grandmother Grandfather Aunt Uncle Brother Sister Foster parent Guardian Significant Other Husband Wife Friend Other
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
Will you be able to fit this commitment in with your other school and home responsibilities? *
Yes
No
I don't know
I have talked to my parent(s)/guardian(s) about applying to the LearnServe Fellowship program. *
Yes, and they are supportive
Yes, and they have some questions
Not yet
How did you find out about the LearnServe Fellows Program? *
Friend
Online
Parent
Teacher
Cathedral Scholars
Other
If other, please explain.
Yes, and they are supportive
Yes, and they have some questions
Not yet
Please fill out the captcha on the right.
