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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.
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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?
________________________________________________________________________
________________________________________________________________________
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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:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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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
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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.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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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.