Name (Last, First, Middle) s1

Youth Application www.conservationcorps.org

Conservation Corps MN – Youth Programs Mail, Email or Fax [email protected] 60 Plato Blvd E, Suite 210 completed application to: 651-209-9901 (Fax) St. Paul, MN 55107 Name Last: First: Middle:

Address House #: Street Name: Apt #: P.O. Box:

City: State: Zip Code: Email Address ([email protected]) Please print clearly: Personal e-mail: Parent/Guardian e-mail: Check the program you are applying to: (you may make multiple selections) Home Telephone Number (Include area code) ( ) - Youth Outdoors Spring Session Cell Phone or Pager (Include area code) Summer Session (4 weeks) ( ) - Fall Session Social Security Number (333-22-4444) Summer Youth Corps - - Session 1 (mid-June through mid-July) Gender: Male Female Other Session 2 (mid-July through mid-August) Either Session 1 or 2 (cannot be accepted to both) Date of Birth:(MM/DD/YYYY) / /

2nd year Summer Youth Corps (Returners only) Age at program start date: 15 16 17 18 Youth Leader (8-week) (one week off mid-summer) Are you currently enrolled in school? Wilderness Crew Member (4-week) Yes No School Name: Session 1, Session 2 Either session 1 or 2 How did you learn about Conservation Corps I have applied to Conservation Corps before: Yes No Minnesota? (please be specific): If yes, what year? I have worked for Conservation Corps before: Yes No If yes, what year? Required Signatures I understand that the Conservation Corps Minnesota Youth Programs are work/education programs designed to accomplish environmental and community work and provide a unique youth development experience. I hereby certify that all statements made in this application are true and correct. Applicant’s Signature: Date: / /

Parent or Legal Guardian Name (Please Print):

Parent or Legal Guardian Signature: Date: / / If emailing: By typing in your names, you verify that all statements made in this application are true and correct. Page 1 of 11 Short AnswerApplication Questions Page

The following questions must be answered (neatly written or typed) by the applicant. You may answer on a separate piece(s) of paper if you prefer. A. Youth crew members are expected to work very hard on difficult projects. Why do you want to be a crew member rather than working at an easier job?

B. What are your greatest strengths and weaknesses? What will you do to overcome these weaknesses?

C. A portion of the Youth Program requires learning about the environment and community. What would you like to learn about? Why?

D. Joining Conservation Corps Minnesota means making a commitment to finish what you start, and being able to honor that commitment. Describe a time when you kept your word although it was really hard to do.

E. What unique perspective will you bring to Conservation Corps Minnesota? (Examples could include your life experience, special interests, culture, skills, etc.)

*Youth crew members who have already served in a Conservation Corps Minnesota Youth Program do not need to complete reference forms (pgs 5-8), but should prepare for a phone interview in addition to this application.

Short Answer Page Dear Parent or Guardian, Conservation Corps Minnesota is funded through multiple sources that request we report on the diversity of youth interested in our programs. Completing the following questions helps to ensure continued and future funding. Thank you for your cooperation. If you have any questions, please contact the Program Manager at 651-209-9900 x11. The following information is optional.

Deaf and Hard of Hearing Questions Interpreters will be provided for participants who rely upon American Sign Language. On average, the Summer Youth Corps is comprised of 20% deaf and hard-of-hearing youth and staff. Conservation Corps Minnesota makes reasonable accommodations. Are you deaf or hard-of-hearing? Yes No If yes, what is your preferred mode of communication? American Sign Language (ASL) If yes, then please continue in this section. Signing Exact English (SEE) Otherwise go to the next section. Cued Speech Do you wear a hearing aid? Yes No Spoken English

Do you wear a cochlear implant? Yes No Degree of hearing loss (please check one) Mild (20-40 db) Do you rely on a sign language interpreter to Moderate (40-60 db) communicate? Severe (60-75 db) Yes No Profound (75-over db)

Race and Ethnicity Question Indicate the ethnicity and/or race of the youth participant (optional):

African (Please specify ) African-American (Please specify )

American Indian (Please specify ) Anglo/Caucasian (Please specify )

Asian (Please specify ) Hispanic/Latino/Chicano (Please specify )

Multi-Racial (Please specify ) Other (Please specify )

Thank you for your contribution.

Optional Answer Page Page 3 of 11 Information for the Applicant (Remove this page and keep for your reference)

Application Checklist

Application page (p. 1)

Short answer page (p. 2)

Optional information page (p. 3)

Two adult reference forms (p. 5-8)

Application Deadlines

Youth Outdoors (spring session) – Applications due February 24, 2012

Summer Youth Corps sessions 1 and 2 (4 weeks each) – Applications due April 20, 2012

Summer Youth Outdoors (4 weeks) – Applications due June 1, 2012

Youth Outdoors (fall session) – Applications due August 3, 2012

Brief Program Information:

Youth Outdoors (spring session) –  Dates: March 20 - June 5, 2012  Who can apply? St. Paul and Minneapolis residents ages 15-18 on program start date (no exceptions).  Work locations: St. Paul and Minneapolis area

Summer Youth Corps: Session One (4 weeks) –  Dates: June 16 - July 14, 2012  Who can apply? Any youth ages 15-18 on program start date (no exceptions.)  Work locations: Various locations around the state and neighboring states.

Summer Youth Corps: Session Two (4 weeks) –  Dates: July 21 - August 17, 2012  Who can apply? Any youth ages 15-18 on program start date (no exceptions.)  Work locations: Various locations around the state and neighboring states.

Summer Youth Outdoors (4 weeks) –  Dates: July 9 - August 3, 2012 (youth work Mon-Fri and return home for weekends.)  Who can apply? Twin Cities residents ages 15-18 on program start date (no exceptions.)  Work locations: Various Locations around the state.

Youth Outdoors (fall session) –  Dates: Sept 4 - November 20, 2012  Who can apply? St. Paul and Minneapolis residents ages 15-18 on program start date (no exceptions).  Work locations: St. Paul and Minneapolis area.

If you turn in an application and later decide you are not able to participate: please call 651-209-9900 or e-mail [email protected] to let us know. Thank you!

Application Checklist Page To request confirmation that your application has been received completely, E-mail: [email protected].

of 11 Reference Form To Be Completed By the Applicant: Please neatly write your contact information and the name of the adult reference (Teacher, coach, counselor, supervisor, etc. Not family or friends.) This form can be turned in either with your application or have each reference mail or fax it directly to our office. Only complete applications on the program due date will be processed and considered.

Program(s) applying for: Applicant Name Youth Outdoors Summer Youth Corps Address Spring Session Session 1 (4-week) Phone Number Summer (4-week) Session 2 (4-week) Name of person writing reference Fall Session

To Be Completed By the Reference: The person above is applying for a position with Conservation Corps Minnesota. This program engages youth in natural resources work, community service, and education activities. Your comments will help the Conservation Corps select youth participants who will benefit from and add positively to the program. We appreciate your honest reference.

Please mail or fax to: Conservation Corps Minnesota Youth Programs Deadline for applications and reference forms: 60 Plato Blvd E, Suite 210  Youth Outdoors (spring session) – Feb. 24, 2012 St. Paul, MN 55107  Summer Youth Corps (4-week session 1) – April 20, 2012 Fax: 651-209-9901  Summer Youth Corps (4-week session 2) – April 20, 2012 Any questions?  Summer Youth Outdoors (4-week) – June 1, 2012 Visit: www.conservationcorps.org  Youth Outdoors (fall session) – August 3, 2012 E-mail: [email protected] Reference Information

Name Email Address

Address (Street, City, State, Zip)

Telephone Number (Include area How long have you known the Relationship code) applicant? ( ) - ext. Please rate the applicant in the various areas using the number rating below. Comments are greatly appreciated.

Outstanding Satisfactory Unsatisfactory 5 4 3 2 1 Attitude towards work 5 4 3 2 1 Comments:

Attitude towards supervisors 5 4 3 2 1 Comments:

Ability to follow directions 5 4 3 2 1

of 11 Comments:

Reference Form Page 2

Applicant’s Name: Last: First: Ability to take initiative 5 4 3 2 1 Comments:

Ability to get along with others 5 4 3 2 1 Comments:

Maturity 5 4 3 2 1 Comments:

Ability to adapt to new situations 5 4 3 2 1 Comments:

1. How do you think a position with Conservation Corps Minnesota would benefit this person?

2. Please describe what you consider to be the applicant’s major strong points.

3. Please describe what you consider to be the applicant’s main limitations.

4. Please use this space, or additional sheets, to include anything else about the applicant that may be helpful in dete rmining his/her qualifications.

of 11 Signature: Date:

Printed Name: Title:

of 11 Reference Form To Be Completed By the Applicant: Please neatly write your contact information and the name of the adult reference (Teacher, coach, counselor, supervisor, etc. Not family or friends.) This form can be turned in either with your application or have each reference mail or fax it directly to our office. Only complete applications on the program due date will be processed and considered.

Program(s) applying for: Applicant Name Youth Outdoors Summer Youth Corps Address Spring Session Session 1 (4-week) Phone Number Summer (4-week) Session 2 (4-week) Name of person writing reference Fall Session

To Be Completed By the Reference: The person above is applying for a position with Conservation Corps Minnesota. This program engages youth in natural resources work, community service, and education activities. Your comments will help the Conservation Corps select youth participants who will benefit from and add positively to the program. We appreciate your honest reference.

Please mail or fax to: Conservation Corps MN Youth Programs Deadline for applications and reference forms: 60 Plato Blvd E, Suite 210  Youth Outdoors (spring session) – Feb. 24, 2012 St. Paul, MN 55107  Summer Youth Corps (sessions 1 & 2, 4-week) – April 20, 2012 Fax: 651-209-9901  Summer Youth Outdoors (4-week) – June 1, 2012 Any questions?  Youth Outdoors (fall session) – August 3, 2012 Visit: www.conservationcorps.org E-mail: [email protected] Reference Information

Name Email Address

Address (Street, City, State, Zip)

Telephone Number (Include area How long have you known the Relationship code) applicant? ( ) - ext. Please rate the applicant in the various areas using the number rating below. Comments are greatly appreciated.

Outstanding Satisfactory Unsatisfactory 5 4 3 2 1 Attitude towards work 5 4 3 2 1 Comments:

Attitude towards supervisors 5 4 3 2 1 Comments:

Ability to follow directions 5 4 3 2 1

of 11 Comments:

Reference Form Page 2

Applicant’s Name: Last: First: Ability to take initiative 5 4 3 2 1 Comments:

Ability to get along with others 5 4 3 2 1 Comments:

Maturity 5 4 3 2 1 Comments:

Ability to adapt to new situations 5 4 3 2 1 Comments:

5. How do you think a position with Conservation Corps Minnesota would benefit this person?

6. Please describe what you consider to be the applicant’s major strong points.

7. Please describe what you consider to be the applicant’s main limitations.

8. Please use this space, or additional sheets, to include anything else about the applicant that may be helpful in dete rmining his/her qualifications.

of 11 Signature: Date:

Printed Name: Title: