LearnServe International 2020-2021 Fellows Application

Thank you for your interest in the LearnServe Fellows Program. Please complete the following application to be considered for the LearnServe Fellows 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. Questions? Contact Florence Rivkin at florence@learn-serve.org.

**Please note that even with COVID-19, our program will continue! However, depending on guidelines it may be partially virtual.

Demographic Information

First Name *

Last Name *

Your Email *

Cell Phone *

Home Phone *

School *

School Type *

If you selected "Other" or if you were not nominated by your school, please list your school or nominating organization.

Expected high school graduation year *

What are your preferred pronouns? *

Ethnicity (please check all that apply) *

African-American
Asian
Caucasian
Hispanic
Middle Eastern
Native American
Other

Date of Birth (mm/dd/yyyy) *

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

Dietary Restrictions? *

Do you receive free or reduced price lunch from your school? *

Do you receive Medicaid benefits? *

Do you intend to apply for a scholarship? *

Street Address *

City *

State *

Zip Code *

Ward/County *

If applicable, name of nominating teacher or LearnServe advisor:

Name of your school advisor *

Email address of your school advisor *

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)

Application Questions:

You can answer these questions in sentences or bullet points - up to you! 2-4 sentences/bullets for each question will suffice!

Describe previous work experience, and/or responsibilities at home, if any. *

What other extracurriculars are you involved in? What are your hobbies/talents? Do you have any leadership positions? *

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.) *

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

What do you hope to learn from the LearnServe Fellows Program, and what would you hope to offer the other LearnServe Fellows if you are selected? *

Additional Questions

The LearnServe Fellows Program is an extensive leadership training program that requires a commitment of time and effort. This includes weekly meetings from September through March, with 1-2 weekend meetings, special events, and the development and implementation of an action project in your school.

Will you fit LearnServe Fellows into your schedule? *

The LearnServe Fellows Program meets on Thursday afternoons from 4:30 - 6:30pm. Normally we meet in-person, however we will meet virtually until it is safe to do otherwise.

Will you be able to attend these weekly program meetings? *

Do you have access to Zoom through a phone or computer? *

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

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

Please fill out the captcha on the right.

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LearnServe International 2020-2021 Fellows Application

Demographic Information

Parent/Guardian Information

Application Questions:

Additional Questions