2010 Globetrotter Student/Leader Nomination/Application Form

 

_______________________Student Nomination _____________________________

 

Nominator Information - To be filled out by the person nominating a student
Full Name:
E-mail:
Phone Number  
Address  
Nominee's Name: 
Nominee's School: 
Student's Grade/Age: 

In what capacity do you know the nominee:
Briefly tell us about the impact (you feel) the Globetrotter Program could have on the Nominee's life: 
Can you speak to the nature of this student's environment outside of school? (Parents, Family, Friends, Etc.) 
Are there unique skills or personality traits that this candidate could contribute to a Globetrotter team? 
Would you have an interest in being included in Program activities?
Have you nominated a student for this program in the past?

_________________________Student Application__________________________

 

Student Application - to be filled out by the student

 

Student Name
School
Address
City/State/Zip
Birth Date (mm/dd/yyyy)
Email Address
Home Phone (area code-xxx-xxxx)
Cell Phone  (area code-xxx-xxxx)
Parent or Guardians Name
Approximate Family Income
Have you traveled outside the US?
     If so where?
How do you resolve conflict?
What is your biggest fear?
If you had unlimited resources, what would you do to solve the AIDS epidemic in Africa?
In my free time I . . . .
How do you feel about apartheid?
Finish the following sentence: "I wish…"
In one sentence, tell us why you want to be a part of a Dustin's GreenHouse Globetrotter Team?
If you had to rank your personality based on the following traits, with a 6 being the most like you and a 1 being the least like you, how would you order the following? (Remember to rank each "trait" with a number 1-6, not using any number twice.)  
Dynamic/Outgoing
Funny
Intellectual
Confident
Reserved/Shy
Athletic
The Globetrotter Program can include strenuous work and/or exercise. Recognizing this, please list any health issues or concerns that we should know about so that they can be planned for accordingly. (Examples: asthma, allergies, etc.)
Do you have any special skills, abilities, talents you think would be beneficial to the group?
     If so explain
Would you need transportation assistance getting to and from team meetings?
Do you know how to swim?    

 

 

___________________________Leader Application_______________________________

 

 

Leader Application (to be submitted by people interested in being a chaperon on the Globetrotter trip)

Name
Address
City/State/Zip
Home Phone
Cell Phone
Email
Profession
     If a teacher, which school/subject?
What impact do you or could you have on students (Financial/Volunteer/Teaching/Support)
The Globetrotter Program can include strenuous work and/or exercise. Recognizing this, please list any health issues or concerns that we should know about so that they can be planned for accordingly. (Examples: asthma, allergies, etc.)
Do you have any special skills, abilities, talents you think would be beneficial to the group?  If so, please list  
Can you afford to pay your own way? (Trips generally cost about $4000)
Can you afford to sponsor a student scholarship for the trip?