HSLP Application

Haiti Service Learning Program Application

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Occupation *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Skills and Education

Highest Level of Education *

Special training, skills, hobbies *

(For current students)

Current School *

Major/Program of Study *

Anticipated Graduation Year *

Short Essays

Please provide 1-2 paragraphs responses to each the questions below.

Why are you interested in participating in the Haiti Service Learning Program? *

You are going to be far away from your home-base. How do you imagine you will manage your stress, and what inner resources have you used in the past? *

Describe any relevant education or work experience you have that (directly or indirectly) relate to the program’s goals. *

What are your expectations for a trip to Haiti and what do you hope to gain from this experience? *

Tell us a little about groups you have participated in (community service, support, teams, clubs, etc.) and what qualities do you bring to new groups? *

please specify: *

References

Please list three people who know you well and can attest to your character, skills, and dependability. Include your current or last program advisor and/or employer.

References 1

Name *

First

Last

Phone Number *

Email *

Relationship to you *

Length of relationship *

References 2

Name *

First

Last

Phone Number *

Email *

Relationship to you *

Length of relationship *

References 3

Name *

First

Last

Phone Number *

Email *

Relationship to you *

Length of relationship *

Please read the following carefully before submitting this application:
I understand that this is an application for and not a commitment or promise of selection into the program. I certify that I have and will provide information throughout the selection process, including on this application for the Haiti Service Learning Program and in interviews with Expressive Arts Place LLC that is true, correct and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that information contained on my application will be verified by Expressive Arts Place LLC. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for participation in the Haiti Service Learning Program with Expressive Arts Place LLC or my termination as a participant.

Submit

Haiti Service Learning Program

Haiti Service Learning Program Application

Skills and Education

Short Essays

References

References 1

References 2

References 3

Make room for the arts!

Hours

Telephone

Email