2018-2019 Garden State MOSAIC Application

2020-2021 Garden State MOSAIC Applications Now Being Accepted

Garden State MOSAIC is a free, multi-faith educational and leadership program offered to teens in the 8th - 12 grades. Prospective students must submit application forms by Sunday, October 4, and a selection process is used to assure adequate diversity and balance in the program. Most program sessions are held at locations in Central Monmouth County. Sessions are conducted on Sunday afternoons, from 3:30 - 5:30 p.m., roughly every other week (adjusting asneeded for holidays), and include a presentation by the youth of the faith group that is hosting that session. Students have the opportunity to earn volunteer service hours for each session and special service projects attended. They are eligible to get a completion certificate if they attend 60% of the year's faith sessions and participate in at least one of the special service projects. The full MOSAIC calendar is posted on www.GardenStateMOSAIC.org.

The kickoff session is being planned and will be announced shortly. This session is MANDATORY for all participants.

Full Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

What grade are you entering in September of 2020?

Grade 8 Grade 9 Grade 10 Grade 11 Grade 12

What school do you attend, in what town?

Gender

Male Female Prefer not to answer

Cell Phone Number *

Area Code Phone Number

E-mail *

Parent's/Guardian's Name *

Parent Guardian First Name Parent Guardian Last Name

Parent's/Guardian's Phone Number *

Area Code Phone Number

Parent's/Guardian's E-mail *

How did you hear about Garden State MOSAIC?

A family member or friend has been involved in the past. My parent heard about MOSAIC and suggested that I apply. My clergy suggested that I apply. My guidance counselor suggested that I apply. I learned about MOSAIC on social media, or in traditional media. I met an Alumni Ambassador. I saw a flyer hanging in the community. I am an alumnus.

If you subscribe to a particular Belief System, Religion, or Faith, please tell us which. NOTE: "none" or "undecided" is an answer.

...If you answered "None" or "other" in the above question, please explain here.

Please tell us which congregation you belong to and where is it located.

Is your congregation hosting a faith session in this year's MOSAIC program?

YES. NO.

Also, if there is a clergy member or youth director at your congregation whom we can contact to see if your congregation would like to host a faith session, please provide the name and telephone number.

Please tell us why you want to participate in Garden State MOSAIC and what you hope to get out of the program. *

Do you have any allergies or do you require any special accommodations we should know about?

I understand that participation in Garden State MOSAIC involves attending at least 60% of the faith sessions and participating in at least one of the joint service projects scheduled throughout the year, and that unless I do so, I will not receive the certificate of completion.

YES. NO.

Is this your first year attending MOSAIC? *

Yes No

Would you like to be considered for becoming an Alumni Ambassador for the year 2020-21?

Yes No

If you want to become an ambassador, please state what experience you have in holding leadership positions in the past and why you think being an ambassador will be the right next step in your participation in the MOSAIC program.

Please give an example from school, youth group, or other activity where you made decisions that affected the group.

Please note, that if you are selected to participate in Garden State MOSAIC, you will be asked to agree to make every effort to attend the majority of sessions and to respect your fellow students and all those involved. These expectations can be found on our website, and will be distributed at our first meeting.