Trip of a Lifetime - Summer 2013 Application

7/30/2019 Trip of a Lifetime - Summer 2013 Application

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Trip of a Lifetime:

Summer 2013 ApplicationMailing Address: P.O. Box 185 H, Scarsdale, NY, 10583

Email Address: [email protected]: www.projecttoal.orgFax Number: (914) 513-2767

Information:

YouareapplyingforafullgrantprovidedbyTripofaLifetime,anon-profitorganization,forateentourorcommunityservicetripthissummer.Ifselected,the

dateandlengthofthetripwillbeannouncedinlateSpring.Formoreinformation

abouttripoptionsandtheapplicationprocess,pleasevisitourwebsite:

www.projecttoal.org.Tobeeligible,youmustcurrentlybeintheninthgrade.Ifyou

areinthetenthgrade,youcanstillapplywithyourcounselorspermission.

Pleasenotethatsubmittinganapplicationisnoguaranteeofreceivingagrant.

Unfortunately,wereceivemoreapplicationsthanthenumberofapplicantswecan

accept.Allinformationreceivedinthisapplicationwillbekeptstrictlyconfidential.

Directions:

1. PleasefilloutPartOneandPartTwooftheStudentApplication.

2. Pleasehaveyourparent/guardiancompletetheParent/GuardianApplication.

3. HaveyourguidancecounselorfillouttheGuidanceCounselorApplicationand

havethemattachacopyofyourtranscripttoit.

4.Returnboth theStudentApplicationandtheParent/GuardianApplicationby

March15,2013,byMail,Fax,orEmail.


2/9

Student Application:

PartOne:BackgroundInformation

Directions:Pleasecompletelyfillouttheinformationbelow.Themoreinformationwereceive,thequickerwewillbeabletomakeourselections.Failuretofullycompletethissectioncanresultinthedisqualificationofyourapplication.Pleasecompletethe

optionalsectionsifapplicable.

StudentName:______________________________________________

Gender:M()F()

Birthday(mm/dd/yy):__________________________

CurrentAge:_________________________________

StreetAddress:__________________________________________________________

City:______________________State:_____________ZipCode:____________

PrimaryPhone1:_________________________

PrimaryPhone2(Optional):____________________

School:__________________________________________CurrentGrade:_______

EmailAddress(Required):_________________________

Studentliveswith:OneParent()BothParents()Guardian()

AreyouanAmericancitizen?Yes()No()

Doyouhaveapassport?Yes()No()Iamgettingoneby6/1/2013()

GPAonlastreportcard:__________________

Areyouinterestedinparticipatinginacommunityservicetrip?Ifyouarenotselected

foracommunityservicetrip,youwillstillbeconsideredforatraditionalteentour.

Yes()No()

HowdidyoufindoutaboutTripofaLifetime?

________________________________________________________________________

________________________________________________________________________


3/9

DoyouknowanyonewhopreviouslyreceivedatravelgrantfromTripofaLifetime?

Yes()No()

Ifso,who?Whatistheirrelationshiptoyou?(e.g.sister,cousin)?

____________________________________________________________

PartTwo:PersonalResponses

Directions:Pleaserespondtothequestionsbelow.

Whatisyourfavoriteplacetovisitandwhy?(2-3sentences)

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

HaveyoutraveledoutsidetheNortheastbefore(e.gtoFlorida,California,etc.)?Ifso,

telluswhereyouhavebeen.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Whataresomeofyourhobbies?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Pleaselistanyclubs,sports,andcommunityserviceactivitiesyouareinvolvedin,either

inhighschoolorinyourcommunity.

________________________________________________________________________________________________________________________________________________

________________________________________________________________________

ShortResponseQuestions:Wewanttogetasenseofwhoyouare!


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FavoriteMovie___________________________________________

FavoriteTelevisionShow___________________________________

FavoriteBook____________________________________________

FavoriteMusicalArtist_____________________________________

FavoriteSubjectinSchool_________________________________

HiddenTalent___________________________________________

LongResponse:

Pleasereadthefollowingdirectionscarefully:

AnswerTWOofthefollowingfivequestionsin250wordsorlessandattachyour

answerstothisapplication.WecannotreviewyourapplicationunlessyousubmitBOTH

ofyouressays.Additionally,ifyouindicatedinterestingoingonacommunityservice

trip,youMUSTanswerquestion6(inadditiontotwoofthefirstfivequestions).Your

essaysshouldbeTYPED,doublespaced,andin12pointfont.Placeindicatewhich

questionsyouhavechosen.Usetheseessaysasanopportunitytoshowuswhoyouare,

andwhatmakesyouuniqueasanindividual.

1. Discussapersonthathasinfluencedyou.Howdoyouthinkyourlifehasbeenmadedifferentbecauseofthisrelationship?Whatimportantthingshaveyou

learnedfromthispersonthathavecarriedoverintootheraspectsofyourlife?

2. Describeanexperience,achievementorriskyouhavetakenthathaschangedyouasaperson.Thiscouldbeanegativeexperiencethatyoulearnedfrom,a

positiveexperienceorachievementthatyouareproudof,orariskthathas

helpedyougrowasaperson.

3. Ifyoucouldhavedinnerwithanythreepeople(pastorpresent,realorfictional,celebrityorfriend),whowouldyouchooseandwhy?Bespecific!Telluswhat

youhopetogainfrommeetingthesethreepeople.4. Whatarefiveitemsonyourbucketlist(thingsyouwanttodoinyourlifetime)?

Explainwhyyouchoseeachofthefivethings.Theycanbeplacesyouwantto

visit,peopleyouwanttomeet,goalsyouwanttoaccomplish,etc.

5. Wheredoyouseeyourselfin5(10?)years?Whatdoyouhopetohaveaccomplished?Whatdoyouhopetobeworkingtowards?Whohaveyou

becomeandwhoaretheimportantpeopleinyourlife?


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6. PleaseAnswerThisQuestionIf(AndOnlyIf)YouAreApplyingForaCommunityServiceTrip:Whattypeofimpactdoyouhopetomakefromgoing

onthistrip?Whatdoyouhopetolearnfromthistrip?

Onceyourapplicationisprocessed,wewillcontactyouwithnextsteps.

Pleaseprovideanyadditionalinformationaboutyourselfthatyouwouldlikeusto

know:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________


6/9

Parent Application:

PartOne:FinancialInformation

Directions:Pleasecompletelyfillouttheinformationbelow.Allinformationwillbekeptcompletelyconfidential.Ifyourchildischosenasafinalistforthesegrants,youmaybe

askedtoprovidecopiesoftaxreturnsandotherproofsofincomesuchaspayrollstubs.

Howmanyfamilymembersaresupportedbyyourfamilysincome?

_____________________

Howmanychildrenwillbeattendingcollegenextyear?__________________

Iftherearechildrenattendingcollege,pleaseincludetheirnamesandtheschoolsthey

willbeattending.

________________________________________________________________________

________________________________________________________________________

Whatisyourestimatedtotalfamilyincomefor2013?

()$0-24,999()$25,000-$49,999()$50,000-$74,999()$7,5000-$99,999()

$100,000+

Doesyourchildqualifyforthefreelunchprogram?Yes()No()

Hasyourchildeverreceivedfinancialaid,whichincludesbutisnotlimitedtothe

programslistedbelow?

______________________________________________________________

SupplementalSecurityIncome,FoodStamps,TemporaryAssistanceforNeedyFamilies

(TANF),SpecialSupplementalNutritionProgramforWomen,Infants,andChildren(WIC)

Ifyes,pleasestatewhichprogramsanddates:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Ifyoudonotreceivegovernmentassistance,pleaseattachyourlatestproofofincome

(suchasataxreturnorpayrollstub)tothisapplication


7/9

PartTwo:InformationaboutYourChild

Directions:Pleaseanswerthequestionsbelowin1-2sentences.Makesuretoneatly

writeortypeyourresponses.

Whatmakesyourchildagoodcandidateforasummertravelprogram?

________________________________________________________________________

________________________________________________________________________

Whatdoyouthinkyourchildwouldtakeawayfromthisprogram?Howdoyousee

theirlifeand/ortheirinvolvementinyourcommunitybeingpositivelyaffected?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Listfiveadjectivestodescribeyourchild:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Listanyuniquetalentsorhobbiesyourchildpossessesorenjoys:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Doesyourchildhaveanysocial,learning,oremotionalissuesidentifiedbyaqualified

professional(doctor,socialworker,psychologist,etc.)?Ifso,pleaseexplain.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Hasyourchildeverbeenchargedwithorbeenarrestedforacrime?Ifso,pleaseexplain.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________


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Hasyourchildeverbeensuspendedorexpelledfromschool?Ifso,pleaseexplain.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Pleaseprovideanyadditionalinformationthatweshouldtakeintoconsideration.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________


9/9

Agreement Form:

Directions:Pleasereadandsignthestatementbelow.Wecannotconsideryoufora

grantunlessthisagreementformiscompleted.

Iherebycertifythattheinformationprovidedinthisapplicationis,tothebest

ofmyknowledge,trueandcorrect.Ihavenotknowinglywithheldanyfactsor

circumstancesthatcouldjeopardizeconsiderationofmynomination.Iamawarethat

anyknowingmisstatement,falserepresentation,orotherinaccuracycouldsubject

metopenalties,includingpaymentofdamages,totheextentpermittedunderlaw.In

addition,IauthorizethehighschoolIhaveattendedtoreleasetoTripofaLifetime,if

requested,mytranscriptsandotheracademicorfinancialinformationrequestedby

TripofaLifetimeforthepurposesofdeterminingmyeligibilityforthescholarship

providedbyTripofaLifetime.Bysubmittingthisapplicationform,IamgivingTripofaLifetimepermissiontoverifyinformationonthisform.Also,allstudentsselectedfor

thegrantwillberequiredtowriteanessaywithinfifteendaysaftercompletionof

theirtripwhichwillbepostedonourwebsiteandcanbeusedinanypromotionalor

fundraisingeffortsbythecharity.

StudentSignature__________________________________________

Parent/GuardianSignature___________________________________

Date_____________________________________

Foradditionalinformationregardingtheapplicationprocess,pleaseviewtheTripofa

Lifetimewebsite-www.projecttoal.orgoremailusatwebmaster@projecttoal.org. Ifthere

arestillquestions,pleasecontactyourdeanorguidancecounselorwhowillbeincontact

withtheorganization.Oncewereceiveyourapplication,wewillfollowupwithyoutoconduct

ourinterview.WeexpectallgrantdecisionstobemadebyApril15th.

TripofaLifetime,Inc.offerstohighschoolstudentsofanyrace,color,creed,nationalorigin,gender,sexual

orientation,andphysicalabilityalltheprivileges,programs,activities,andopportunitiesgenerallyaccordedormadeavailablethroughtheprogram.TripofaLifetime,Inc.doesnotdiscriminateonthebasisofrace,color,

creed,nationalorigin,gender,sexualorientation,ordisabilityinitsselectionofcandidatestoreceivegrantsorin

theadministrationofitsprogram.Allapplicantsmustalsomeetthequalificationsandconditionsofthe

organizationprovidingthetours.

Trip of a Lifetime - Summer 2013 Application

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Transcript of Trip of a Lifetime - Summer 2013 Application