Desmund Tutu Youth Fellow Application
RequiredRequired Question(s)
Required 1.
Name:

 

 

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Required 2.
Address:

 

 

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Required 3.

City:

 

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Required 4.

State:

 

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Required 5.

Zip Code:

 

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Required 6.

County:

Marion
Boone
Hamilton
Madison
Hancock
Shelby
Johnson
Morgan
Hendricks
7.
Home Phone:

 

 

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Required 8.

Cell:

 

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Required 9.
Date of Birth:

 

 

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Required 10.
Email:

 

 

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Required 11.

Are you a U.S. Citizen? 

Yes
No
12.
If NO, are you an eligible non-citizen?

 

Yes
No
13.
If YES, list your alien registration number:

 

 

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Required 14.

Do you have a current passport?

Yes
No
Required 15.

State of legal residence:

 

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Required 16.
Name of Legal Guardian:

 

 

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Required 17.
Relationship to Legal Guardian:

 

 

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Required 18.

Legal Guardian's Phone Number:

 

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Required 19.

Legal Guardian's Email:

 

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Required 20.
Have you traveled outside of the country before?

 

Yes
No
21.
If YES, where:

 

 

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Required 22.
Have you ever been convicted of a misdemeanor or felony?

 *Please note that this will not preclude your chances of selection.*

Yes
No
23.
If YES, please explain:

 

 

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Required 24.
Are you willing to submit to a background check? 

 

Yes
No
Required 25.
Race:

 

Hispanic/Latino
White
Black or African American
American Indian or Alaskan Native
Asian or Pacific Islander
Other  
Required 26.
What is your mode of transportation?

 

Car
Bus
Bike
Other  
Required 27.
List any volunteer work completed:

 

 

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Required 28.
Number of occupants in your household in 2015-2016

 

 

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Required 29.
Are there other elementary, Jr. high, or high school tuition costs for other dependent children in your household?

 

Yes
No
30.
Please tell us if you have any extenuating financial circumstances:

 

 

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Required 31.
Applicant School Status:

 

In School
Out of School
Required 32.
Does the applicant have a GED? 

 

Yes
No
Required 33.
Is the applicant a high school graduate?

 

Yes
No
Required 34.
Is the applicant a college/vocational graduate?

 

Yes
No
35.

If YES, name of school:  

 

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Required 36.
Is the applicant currently attending school?

 

Yes
No
37.
If YES, name of school:

 

 

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Required 38.

Highest Grade Completed:

9-12th grade
High School Graduate
GED
1-3 years college
Technical/Vocational
Required 39.

Have you ever received financial aid for schooling?

Yes
No
Required 40.
If in high school, do you qualify for free or reduced lunch?

 

Yes
No
Required 41.
Will you have health insurance or Medicaid in 2016?

 

Yes
No
42.
If YES, please list the provider:

 

 

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43.
Please list any allergies, diet restrictions, medications, or health conditions:

 

 

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Required 44.
Are you willing to consent to the vaccinations required for travel to South Africa?

 

Yes
No
Required 45.
Please address the following in an essay that is no more than 600 words, email you essay to Jay Horan at jhoran@peacelearningcenter.org.  Your application will not be complete until your essay is received. 

Drawing on your life experience and your personal and academic goals, describe how you believe you can address pressing social justice issues of our time and reflect on how your project will benefit you and the people, issues, and communities you care about.

Please select "yes" if you understand that your essay must be submitted by email to Jay Horan at jhoran@peacelearningcenter.org, no later than January 1, 2016.
Yes
No