Applicant Information:
Prefix:
*
Please Select
Mr.
Ms.
First Name:
*
Last Name:
*
Preferred Name, if Different.
Birthday: (mm/dd/yyyy)
*
School
*
Grade:
*
Please Select
Current 8th Grader
Current 9th Grader
Current 10th Grader
Current 11th Grader
Current 12th Grader
Telephone Number:
*
E-mail:
*
Street Address:
*
City:
*
State:
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip:
*
Note: We will communicate with you primarily through email. You must provide an email address that is active and that you check regularly.
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Parent/Guardian Information:
Parent/Guardian 1 Name:
Prefix:
*
Please Select
Mr.
Mrs.
Ms.
First Name:
*
Last Name:
*
Relationship to Applicant:
*
Email:
*
Street Address:
*
City:
*
State:
*
Zip:
*
Home Phone:
*
Cell Phone:
Work Phone:
Parent/Guardian 2:
Prefix:
Please Select
Mr.
Ms.
Mrs.
First Name:
Last Name:
Relationship to Applicant:
Street Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Work Phone:
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Next
Please explain why you want to be a U.S. Green Schools Fellow.
*
Please explain what you have done this year or in previous years to help either your school or your community go green and meet their sustainability goals.
*
Please explain how you plan on applying the knowledge skills and tools learned at Sc3 to implement seeds of change in your school, community, and the world during the year following the 2010 Sc3.
*
Upload your resume or any additional information you would like us to have:
Upload a File
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Note: Room and board will cost $500. If necessary, check the following box for financial aid info.
Please send me financial aid forms to fill out.
Special accommodations can be made available upon request. Please list any special needs here:
Certification Statements: Please check the following boxes.
>
*
I certify that all of the information I have provided is accurate.
>
*
I am available and plan on participating if accepted in the U.S. Green Schools Fellows Program. I understand that by checking this box I am committing to attend this summer's conference if accepted.
Applicant's Electronic Signature:
*
Parent/Guardian's Electronic Signature:
*
Submit
Should be Empty: