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Changing Places, Changing Lives
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Stewardship Program Application
ApplicationS submitted by Friday, September 27th will be given priority.
Name
*
First Name
Last Name
Student Email Address
*
Parent/Guardian Email Address
Home Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Home Phone
*
If you don't have one, put zeros in.
(###)
###
####
Cell Phone
*
If you don't have one, put zeros in.
(###)
###
####
How did you learn about this program?
*
How did you find out about this application? A teacher, a friend, guidance counselor, newspaper, Facebook, email list, other?
What school do you attend?
*
Choose one
Achievement First Hartford High School
Bulkeley High School
Capital Preparatory Magnet School
Classical Magnet School
Hartford Magnet Trinity College Academy
Hartford Public High School
R.J. Kinsella Magnet School of Performing Arts
Sport and Medical Sciences Academy
University High School of Science and Engineering
Watkinson School
Weaver High School
Other
If Other, please list school below.
What grade are you in?
*
Choose one
9th
10th
11th
12th
Not in High School
What are your favorite classes?
List any clubs you participate in and what days and times they meet.
Example: Spanish club on Tuesdays from 3 pm to 4 pm.
List any specialized training you have received (ex: car repair, woodworking)
Do you have any work, community service, or volunteer experience?
Choose one
Yes
No
Why would you like to participate in this program?
*
What skills do you hope to gain?
*
What immediately comes to mind when you think of Hartford's physical environment?
*
How concerned are you about the physical environment in Hartford?
*
Not concerned
Somewhat concerned
Concerned
Very concerned
Provide an example of a project related to improving Hartford's physical environment that you would like to work on?
*
Plant a vegetable garden
Clean up a park
Grow flowers
Plant a tree
Educate neighbors about hazards of lead paint
Build bird boxes
Establish a hiking trail
Other
What change would you like to see happen in Hartford, CT?
*
Do you have experience working within a team? (school club, sports team, church group) If yes, what were the benefits of working as a team? If no, how would you contribute to the stewardship team?
*
What do you aspire to do after high-school?
*
How will this opportunity help you achieve your aspirations?
*
Thank you!
