LearnServe International 2018 Abroad Application

Welcome to the LearnServe Abroad 2018 Application! You will need about 15-20 minutes to complete the application. There is no way to save your work without submitting the application, so please make sure that you have sufficient time to complete the form.

If you do have a passport, please have it available to complete the registration process. If you do not have a passport yet, go ahead and apply, and fill out the name as written on your birth certificate. Please also have the contact details of your parents/guardians or other emergency contacts readily available. Be as thorough as possible to help us evaluate your application!

Once you have submitted your application, the LearnServe team will follow up regarding next steps in the application process, including scheduling an interview. Questions? Contact Sabine Keinath at sabine@learn-serve.org.

* indicates a required field

LearnServe Abroad Destination - First Choice *

Jamaica
Paraguay
Zambia
South Africa

LearnServe Abroad Destination - Second Choice (Please indicate a second choice in case your first choice is already filled up. If you do not want to go to any other destination than your first choice, please check the last box.) *

Jamaica
Paraguay
Zambia
South Africa
First Destination Only

Demographic Information

Your Last Name *

Your First Name *

Date of Birth (mm/dd/yyyy) *

Gender *

Ethnicity (please check all that apply) *

African-American
Asian
Caucasian
Hispanic
Middle Eastern
Native American
Other

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

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

Do you receive Medicaid benefits? *

Expected high school graduation year *

School *

School Type *

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

Please give a teacher's name, and their school position title, who can write a short recommendation. Please be sure to ask your teacher if he or she is willing to provide the reference. *

Please provide an email address for your teacher recommendation*

Please provide the name of your school advisor*

Please provide an email address for your school advisor. *

I am a... *

Financial aid is available on a need-based and first-come basis. If you apply for financial aid we will ask for additional information in a separate communication.

Do you intend to apply for a scholarship? *

Are/were you a LearnServe Fellow? *

Yes
No

Have you taken a LearnServe Seeding Social Innovation course at your school? *

Yes
No

Street Address *

City *

State *

Zip *

Ward/County *

Home Phone *

Cell Phone *

Email *

Family Information

Emergency Contact 1 First Name *

Emergency Contact 1 Last Name *

Emergency Contact 1 Relationship to you *

Emergency Contact 1: Same address as you? *

Yes
No

If no, Emergency Contact 1 Address

Emergency Contact 1 Email *

Emergency Contact 1 Home Phone

Emergency Contact 1 Cell Phone

Emergency Contact 1 Work Phone

Emergency Contact 2 First Name *

Emergency Contact 2 Last Name *

Emergency Contact 2 Relationship to you *

Emergency Contact 2 Same address as you? *

Yes
No

Emergency Contact 2 Address (if different from yours)

Emergency Contact 2 Email *

Emergency Contact 2 Home Phone

Emergency Contact 2 Cell Phone

Emergency Contact 2 Work Phone

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

Passport/Traveler Information

Do you have a current passport? Please note that your passport needs to be valid for at least six months from the date of travel - in this case at least until January 2019. *

Yes
No, I will apply for one

What is your exact name on your passport, including middle names? (If you do not yet have a passport, give the name as written on your birth certificate.) *

Your country of citizenship *

Your passport number

Your passport's date of issue

Your passport's place of issue

Your passport's expiration date

What is your level of Spanish proficiency? *

Do you have any dietary restrictions? *

What T-shirt size do you wear? If other, list below *

Other size:

Have you ever traveled outside of the USA? *

Yes
No

Please tell us about any travel you've done outside the USA.

Application Questions

Do you currently have a job?

If you are a DC resident, do you intend to apply for Summer Youth Employment Program?

Describe any school, community, or volunteer activities that you participate in. Share how your are involved in school life and/or any community organizations. Any leadership roles? *

Tell us about your special talents, hobbies, or interests. *

What is an issue or cause you are passionate about, and why? (Please describe this in detail.) *

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

Why do you want to participate in LearnServe Abroad? What do you hope to gain from the experience? Please explain your expectations. *

The LearnServe Abroad Program is not just a trip. It is a leadership training program that requires a commitment of time and effort. This includes regular meetings from February through October, fundraising requirements, and the development and implementation of an action project. You will meet a total of 42 hours before and after the trip.

There will be 12 meetings before the trip. Meetings are twice a month, on Saturday afternoons from 2:00-5:00pm March-early May, and Thursday evenings from 4:30-6:30pm late May through late June, with one service day (date TBD). (All meetings are Metro accessible). See the Abroad webpage for more details and the full meeting schedule.

After the trip, there will be 4 meetings, held on Saturdays. These meetings are all mandatory. The tentative schedule is available on the website. Be sure that you discuss this time commitment with your parents/ guardians, and that you are willing to commit to this.

How will you fit LearnServe Abroad with other commitments you may have? Will you be able to attend these monthly program meetings? *

Please check the box on the right.

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LearnServe International 2018 Abroad Application

Demographic Information

Family Information

Passport/Traveler Information

Application Questions