Please print clearly
Project Preference 1st_____________________ 2nd______________________
Dates of the Project_____________ Dates of the Project______________
If applying for LEVEL II Project PLEASE complete 8 – A
1. NAME
____________________________________________________________
LAST FIRST MIDDLE
2. ADDRESS
______________________________________________________________
CITY, STATE, ZIP CODE _________________________________
TEL # ( )________________________ EMAIL __________________________
3. DATE OF BIRTH _______________________
4. AGE /GENDER _________________________
5. SCHOOL, CITY, STATE
________________________________________________
6. CURRENT GRADE ______________
7. PARENT/GUARDIAN:
NAME: ____________________________
NAME:__________________________________
ADDRESS: ________________________
ADDRESS: _______________________________
PHONE #: _________________________
PHONE #: _______________________________
8. COMMUNITY SERVICE EXPERIENCES. LIST VOLUNTEER JOBS, PROJECTS OF WHICH YOU HAVE HAD A PART.
JOB/PROJECT DESCRIBE YOUR ROLE DATES FROM - TO
a_____________________________________________________________________
b_____________________________________________________________________
c_____________________________________________________________________
d_____________________________________________________________________
8 - A If Applying for a Level II Project and have not participated in a Level I Network Summer Service Project, elaborate on how your service work is equivalent to a Level I Network Project.
9. EXTRACURRICULAR ACTIVITIES; LIST ANY OFFICES HELD,TEAMS,CLUBS,COMMITTEES, ETC. OF WHICH YOU HAVE BEEN A PART.
Teams, Clubs etc. Describe Your Role Dates: From – To
A___________________________________________________________________
B___________________________________________________________________
C___________________________________________________________________
D___________________________________________________________________
10. LIST SOME OF YOUR LEISURE ACTIVITIES AND HOBBIES.
11. LIST YOUR EXPERIENCES WITH CHILDREN. INCLUDE THE NATURE OF THESE EXPERIENCES AND THE AGES OF THE CHILDREN.
12. WHAT HAS MADE THE GREATEST IMPRESSION ON YOU IN YOUR SACRED HEART EDUCATION THUS FAR?
13. LIST THE NAMES AND AGES OF YOUR SISTERS AND BROTHERS.
14. WHAT MOTIVATES YOU TO PARTICIPATE IN THIS SERVICE PROGRAM, KNOWING THAT IT MAY NOT SATISFY YOUR SCHOOL’S COMMUNITY SERVICE REQUIREMENT?
15. IF YOU ARE ACCEPTED TO THE PROJECT, ARE YOU WILLING TO LIVE A SIMPLE LIFE STYLE FOR THE DURATION OF THE PROJECT? WHAT DOES THIS MEAN TO YOU?
16. ARE YOU APPLYING TO ANY OTHER PROGRAMS THAT MIGHT CONFLICT WITH YOUR ATTENDING A NETWORK SUMMER SERVICE PROJECT? (SUMMER SCHOOL, CAMP, ETC.)
17. HAVE YOU PREVIOUSLY APPLIED TO A NETWORK SERVICE PROJECT? IF SO WHICH ONE?
________________________________________________________________
Did you participate in it? ________ YES _________NO
18. DO YOU HAVE ANY ALLERGIES OR OTHER HEALTH CONDITIONS WHICH WE SHOULD BE AWARE OF IN ORDER TO ENSURE YOUR FULL PARTICIPATION AND SAFETY?
19. Please indicate the TWO people to whom you have given the Adult Reference for Students Form. They should know you well, be in a position to judge your general character and motivation, and be able to evaluate your qualification for the Network Service Project at this time. You should have a reference from a teacher AND the Dean of Students OR Director of Community Service OR Campus Minister OR Advisor. Please give complete addresses including:
Name Address (street, city, state, zip) Relationship
______________________ ______________________________ ___________
_____________________________ _________________________ _________
_______________ _____________________________ ____________________
_______________ __________________________________ ______________
Students selected to participate in Network Service Projects are responsible for their own transportation costs and will be assessed a non-refundable participant’s fee of $20/Day (Note: ISEA, Project Harvest, and Sprout Creek Conservation Corps. total cost is $360 plus transportation.) DUE THURSDAY MARCH 29, 2007. THIS CHECK IS TO BE GIVEN TO THE COORDINATOR AT THE SCHOOL – THE SCHOOL INTURN WILL SEND ONE CHECK FOR ALL STUDENTS ATTENDING PROJECTS TO THE ‘NETWORK OFFICE’. Limited financial aid is available; see your school’s contact for Network Service Projects for more information.
If selected, I agree to abide by all the rules of the Network summer project, including no use of tobacco, alcohol, or other drugs. I also understand that I am pledging to live simply and in community with others. I will be returning to my Sacred Heart School in the fall (unless I am graduating).
_________________________________________________________________
Your signature Date
________________________________________________________________
Parent/Guardian signature Date
_________________________________________________________________
Signature of Head of High School Date
_________________________________________________________________
Signature of Head of School Date
________________________________________________________________
Signature of School’s Contact for Network Service Projects Date
NETWORK SERVICE PROJECT Summer of 2007
ADULT REFERENCE FOR STUDENTS
PLEASE RETURN THIS TO THE APPLICANT IN A SEALED ENVELOPE THAT YOU HAVE SIGNED ACROSS THE SEAL
By Thursday, February 1, 2007
TO THE APPLICANT: I waive my right of access to this reference form.
Student Signature: _________________________________
Date: ____________________
Printed Student Name: ______________________________
TO THE REFERENCE: The Network Service Project seeks mature, well-balanced students motivated to helping the poor and marginalized. The volunteers live simply and inclusively in community along with the adult staff for a one to two week period of time. Further information on the program is available through your school’s contact for Network Service Projects. We would like you to help us to get to know the applicant as we consider her/his application for acceptance into this program. Please return this form in a signed, sealed envelope to the applicant by February 1, 2007. Thank you in advance for your time and cooperation.
1. What is your relationship to the applicant? How long have you known her/him?
2. Describe how the applicant works and interacts with others.
3. Have you seen the applicant assume a leadership role or display personal initiative? Explain.
4. How does the applicant appear to cope in stressful situations?
5. What would you identify as the applicant’s outstanding strengths? Applicant's weaknesses? How well does the applicant know her/his strengths and weaknesses? Include 3 adjectives that BEST describe the applicant.
6. How would you describe the applicant’s motivation for applying to the Network Service Project?
7. Are you aware of any health issues that may affect this student’s full participation in a Network Service Project? Explain.
Please rate the applicant in the following areas by circling one number
1 = “WEAK” and 5 = ”OUTSTANDING”.
Sense of Humor 1 2 3 4 5 Dependability 1 2 3 4 5
Initiative 1 2 3 4 5 Common Sense 1 2 3 4 5
Effective use of time 1 2 3 4 5 Enthusiasm 1 2 3 4 5
Ability to express feelings 1 2 3 4 5 Ability to work alone 1 2 3 4 5
Ability to get along with others 1 2 3 4 5
Ability to work with others 1 2 3 4 5
Emotional stability 1 2 3 4 5 Ability to handle stress 1 2 3 4 5
Tact in dealing with others 1 2 3 4 5
Ability to work under pressure 1 2 3 4 5
Ability to make decisions 1 2 3 4 5
Ability to adapt to new situations 1 2 3 4 5
Creativity and imagination 1 2 3 4 5
Ability to adapt to unstructured situations 1 2 3 4 5
Ability to work through conflict 1 2 3 4 5
Ability to live with others 1 2 3 4 5
Openness to direction in work 1 2 3 4 5
Verbal communication skills 1 2 3 4 5
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Overall, how would you rate this applicant?
1. _______ Okay, but some reservations
2. _______ Good, better than many
3. _______ Very good, no reservations at all
4. _______ Exceptional, a really rare find.
Your Signature: _____________________________________
Date: _____________________
Relationship to applicant: _____________________________
Phone: ____________________
Student’s Name: ___________________________________
PLEASE COMPLETE ALL PAGES
PLEASE RETURN THIS TO THE APPLICANT IN A SEALED ENVELOPE THAT YOU HAVE SIGNED ACROSS THE SEAL
By Thursday, February 1, 2007