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Welcome Presente Applicant
Please remember this commitment is from February to December. The 1st part meets twice a week. The 2nd part consists of June - December; the time and place is TBD based on placement.
21
Questions
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1
Name
*
This field is required.
First Name
Middle Initial
Last Name
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2
Date of Birth
*
This field is required.
/
Date
Month
Day
Year
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3
Today
/
Date
Month
Day
Year
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4
Age
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5
What gender do you identify with?
*
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Female
Male
Other
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6
What is your race? (Select all that apply)
*
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American Indian or Alaska Native
Asian American/ Pacific Islander
Black or African American
Hispanic, Latino, or Spanish
White
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7
Have you ever had contact with law enforcement?
*
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YES
NO
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8
If yes, select which situation best applies to you.
Informal contact with law enforcement
In the process of whether I need probation
I’m on probation
Previously was on probation
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9
Have you experienced, been diagnosed or seen counseling for any of the following:
*
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Suicide ideation
Eating disorder
Violent behavior
Bipolar disorder
Anxiety
Major Depression
Schizophrenia
Substance abuse
Other
None of the Above
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10
Do you have any social, emotional, or behavioral challenges such as autism, ADHD, OCD, etc.?
*
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YES
NO
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11
Do you smoke and/or drink?
*
This field is required.
YES
NO
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12
Do you need academic support?
*
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YES
NO
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13
Address
*
This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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14
Phone Number
*
This field is required.
Please enter a valid phone number.
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15
Email
*
This field is required.
example@example.com
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16
Parent(s)/Guardian(s) Information
*
This field is required.
First Name
Last Name
Phone Number
Email
2nd Parent/Guardian First Name
2nd Parent/Guardian Last Name
2nd Parent/Guardian Phone Number
2nd Parent/Guardian Email
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17
Education
*
This field is required.
Please Select
High School
College
Please Select
Please Select
High School
College
Level of Education
Name of High School/College
Please Select
Yes
No
Please Select
Please Select
Yes
No
Did you graduate?
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18
What year did you graduate?
*
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19
What is your current grade level?
*
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Freshman
Sophomore
Junior
Senior
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20
1st Reference
*
This field is required.
First Name
Last Name
Phone Number
Please Select
Teacher
Probation Officer
Community Leader
Mentor
Relative
Please Select
Please Select
Teacher
Probation Officer
Community Leader
Mentor
Relative
Relationship
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21
2nd Reference
*
This field is required.
First Name
Last Name
Phone Number
Please Select
Teacher
Probation Officer
Community Leader
Mentor
Relative
Please Select
Please Select
Teacher
Probation Officer
Community Leader
Mentor
Relative
Relationship
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22
Describe your social environment in a few sentences.
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23
Describe an aspect of your identity that is important to you:
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(Your culture/country/nationality/ethnicity/race/gender/physical ability or sexual orientation)
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24
Discuss a major problem that you see facing your community or group today.
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25
Explain why you are a good candidate for this fellowship.
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26
What is your understanding of leadership and what do you expect from the Presente program?
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27
Upload resume/letters of recommendation
Accepted File Types: .pdf, .doc, .docx, .txt, .pages
Please submit your resume/letter of recommendation by January 31st to dreyes@multiculturalmarin.org
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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28
Disclaimer & Signature
*
This field is required.
I certify that my answers are true and complete to the best of my knowledge. If my nomination is accepted, I understand that false or misleading information in my application or interview may result in my disqualification or release from the Fellowship Program.
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29
Parent Signature & Disclaimer
*
This field is required.
If you’re a minor, please provide parent/guardian signature
I certify that my answers are true and complete to the best of my knowledge. If my nomination is accepted, I understand that false or misleading information in my application or interview may result in my disqualification or release from the Fellowship Program.
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