Summer in Guatemala Service-Immersion Trip Application

Please type your answers (1-2 paragraphs each) on a separate sheet and attach. This application is due Friday, January 20, 2017 to Mr. Mattacchione. Due to the date International Samaritan needs the names of accepted students, late applications cannot be accepted. Please note that you must have your parent/guardian signature on the back.

Legal Name on Passport: ______

Passport Country and Number: ______

Mobile Phone: ______Date of Birth: ______

**YOU MUST INCLUDE A COPY OF YOUR CURRENT PASSPORT OR PASSPORT APPLICATION**

Please note that if your Passport expires within six months of the trip (so before December 2016), you will be required by the host country to have a new Passport. RJHS Service-Immersion Trip Mission Statement

The RJHS Immersion Program affirms the dignity of individuals and a compassionate connection to the world community. By facilitating service immersion opportunities, students are challenged to look beyond their worldview, to open themselves to the reality of the people they encounter, and to find God in all things. The Immersion Program's goals are to inspire students to cultivate a commitment to service and justice, live in solidarity with those in the margins of our local and global communities and foster a life-long dedication for serving others.

1) Why would you like to participate in this service-immersion trip? List all of your reasons.

2) What will you bring to this trip? How can some of your past experiences (especially in service and justice at RJHS) aid you in this trip?

3) What do you hope to gain from this experience, and how will you “bring it back” to our greater Regis Jesuit community?

4) How does your understanding of spirituality and community prepare you for an immersion experience with people living in the Third World? 5) We will be checking on your current status in all areas of your RJ life – academics, discipline, counseling, etc. Is there anything that you would like us to know in these areas? PARENT/GUARDIAN PORTION

Please write your responses below.

1) Why do you believe your son should attend this trip?

2) Will your son and/or your family will be able to completely pay for this trip by the deadline of January 31? Failure to pay fully or to work out a payment schedule by this point may result in your son not participating in the Service-Immersion trip. Please be aware that there is some Service-Immersion Scholarship money available. Please contact Mr. Mattacchione at [email protected] for more info.

3) Would your family be interested and/or able to sponsor a student who cannot afford this trip by possibly donating a portion of the fee? If applicable, please indicate how you would be able to help.

I understand that this Service-Immersion Trip is service and justice-based, all school rules apply, and I approve of my son’s application. (Please sign below.)

Parent/Guardian

Name Signature Date Student

Name Signature Date