2022 tSB Core Program Prophet Application

2022 tSB Core Program Application (Prophet)

If you would like to save this application to return to later, you can do so via the link at the bottom of this page!
This application needs to be finished and submitted no later than Wednesday, December 1, 2021!

We will let you know if you have been accepted to the program the week of December 13-17th.

TO COMPLETE THIS APPLICATION YOU WILL NEED:
- About 30 minutes to an hour to complete this application
- Your contact information and household income information
- The names and contact information of 3 references (can be friends, teachers, family, employers, etc.)
IMPORTANT: PLEASE TELL YOUR PARENTS BEFORE APPLYING TO THIS PROGRAM

It's a large time commitment and it works out a lot better if your parents, guardians, and/or families are aware of your desire to participate in Core Program.
Questions? Contact Us!

If you have any questions in regards to filling out this application please feel free to email Program Manager, Shona Kerrick (shona@theserviceboard.org)
Basic Information

Please fill this out as thoroughly as possible!
Name:

First NameLast Name
I go by (preferred name):*

First NameLast NameOther
What pronouns can we use for you?:*

They/ThemShe/HerHe/HimStill figuring it out!Other
Email:*
Cell Phone:*
Date of Birth:*

MonthDayYear
Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Address (if applicable):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What neighborhood do you reside in?: *
Ex: Beacon Hill, Central District, Rainier Beach, Hillman City, Capitol Hill etc...
Home Phone #:
Optional*
Best time to call and preferred means of communication?:*
Call, text, email...etc.
High School:*
Grade:*

9101112Other
Racial Identity: We acknowledge that while race is a social construct, racism is real and continues to disproportionately impact communities of color. We ask registrants to self-identify their racial identity so that we can evaluate our racial equity efforts. Which of the following racial identities do you most identify with? Please check all that apply:*

Black (African American)Black (African)Black (Afro-Caribbean)Indigenous (North America)Indigenous (Central & South America)Alaskan NativeFirst NationsPacific IslanderNative HawaiianAsian (South)Asian (East)Asian (Southeast)Asian (Asian American)Middle EasternLatine and/or LatinxHispanicWhite (European American)Multiracial/BiracialOther
Please describe your ethnic background: *
Ex: Ethiopian, Cuban, Mexican, Vietnamese, etc.
Optional- Do you personally identify as or with any of these things? We ask you for demographic data specifically for grant and funding reporting purposes. This information will remain anonymous when counted and never be shared by any means outside of tSB. (Please select all that apply):

A RefugeeAn ImmigrantHouseless (current, or previous)Previously IncarceratedA VeteranA person with a DisabilityPart of the LGBTQIA+ communitySomeone in Foster Care (current, or previous)
Is any of your immediate family currently serving in the military or a veteran?:*

YesNo
Household Information

Please answer to the best of your ability!
Is English the primary language spoken in your home?:*

YesNo
Language(s) spoken at home:*
Primary Guardian Name:*
Primary Guardian Phone:*
Primary Guardian Email:*
Primary Guardian relationship to you:*
Ex: Mom/Dad, Aunt, Grandparent etc.
Do you live in a single-parent household?:*

YesNo
Household Income (Annual):*
This is strictly for grant purposes- if you as a young person don't know the answer please ask your parent or guardian for this information.
Total number of people in your household:*
Total number of people under 18 in household:*
Are you eligible for free or reduced lunch?:*

YesNoI'm not sure
Do you have reliable access to technology? (Such as - internet connection, computer, laptop, smartphone, or tablet):*

YesNo
Do you have any scheduling conflicts with Wednesday evening (6-8 pm) and Saturday day programming events from January to June 2022?:*
Saturdays (Jan-April) are snowboarding ~7am-2pm // Service Projects (April-June) are usually from 10 am- 2 pm
If selected, will you be able to attend the overnight Core Program retreat on January 22nd-23rd? (There are two retreats per year- one in Jan and one in June)*
Details to come! Only one night stay- return the next day.
Short Medical History

This information is in case of emergency and for your safety. Please be thorough in your responses! We care about your health and well-being.
Do you have any dietary restrictions or preferences?:*
Ex. vegetarian, vegan, halal, kosher, gluten free, etc.
Please list all of your known allergies (including outdoor/ indoor/ food/ prescriptions/medications...etc.):*
Ex: bees, latex, dairy, nuts...etc.
Do you have have any accommodations (physical or otherwise) that you would like to request in order to feel comfortable participating in small group, in-person activities?:*
Please write N/A if none
Have you had any major injuries, diagnoses, or surgeries within the last year?: *
(Especially ones that might be affected by snowboarding or outdoor activities)
If you answered "Yes" to the previous question, please list all medical conditions that tSB staff should be made aware of:
Please type move on to the next question, if not applicable to you
How have you been affected, if at all, by the COVID-19 pandemic? How are you doing emotionally?:*
Don't worry, there are no wrong answers and your answer to this question will not affect your acceptance into the program- just checking in on the community.
We are planning to bring Core Program workshops back to in-person settings in January 2022. We respect that everyone has different comfort levels when it comes to COVID-19 risks. Are you comfortable attending in-person activities at this time? (Masks will still be required at all in-person tSB hosted events):*

I am comfortable being in-person in INDOOR and OUTDOOR settings (with mask usage)I am comfortable being in-person, but only in OUTDOOR settings (with mask usage)I am uncomfortable being in-person in general (with mask usage)I'm unsure - I need to see where we're at in January 2022...
Essay Questions

This is your chance to tell us about yourself. Three word answers are fine, but may not give us the best of idea about who you are.
How did you hear about the Service Board (tSB)?:*
Have you ever been snowboarding before? YES or NO -- If YES, how many times? Did you enjoy it?:*
How do you align with or relate to tSB's Core Values? (Social Justice, Community, Outdoor Adventure, Service):
Read more here: https://theserviceboard.org/about/
What are your plans after high school? What are your dreams?: *
What do you hope to gain from being part of our program?:*
What are two skills or talents you can bring to the Service Board?:*
Who do you look up to and why?:*
These next questions check what fits best for you.

*Keep it real, your answers here won't affect whether or not you get in.* This helps us assess how you might benefit from being a part of tSB programming.
Education

Please select a number between 1 - 5. 1= strongly disagree 2 = mostly disagree 3 = neutral 4 = mostly agree 5 = strongly agree
I am excited to go to school:*
My classes are engaging:*
I get enough support from my teachers to succeed in school:*
I am motivated to pursue continuing education after high school:*
I am proud of my grades in school:*
Employment

Please select a number between 1 - 5. 1= strongly disagree 2 = mostly disagree 3 = neutral 4 = mostly agree 5 = strongly agree
I feel confident about getting my first job:*
I have access to opportunities for developing career skills:*
Community

Please select a number between 1 - 5. 1= strongly disagree 2 = mostly disagree 3 = neutral 4 = mostly agree 5 = strongly agree
I have at least one adult who I feel comfortable talking to about challenges in my life:*
I identify with a community group outside of school:*
I frequently engage in after school activities and programs:*
Adventure

Please select a number between 1 - 5. 1= strongly disagree 2 = mostly disagree 3 = neutral 4 = mostly agree 5 = strongly agree
I engage in activities that challenge my comfort zone:*
I am comfortable in the outdoors:*
I have been on multiple camping trips with my family or friends:*
Please select a sliding scale payment option

NO ONE WILL BE TURNED AWAY FOR INABILITY TO PAY. If you are accepted into the program, we will send you a payment form to go over with your family. There are multiple way to pay including monthly installments.
Sliding Scale Payment Options (Please select the option you believe you will want to utilize if selected for the 2022 Core Program):*

Option One: 100% payment of $430Option Two: 75% payment of $322.50Option Three: 50% payment of $215Option Four: 25% Payment of $107.50Option Five: Pay what you can (we ask that each student contribute at least 5 dollars each snowboarding trip to give to our bus driver as tip.)
Please provide three references. Your references may be friends, neighbors, teachers, employers or family members.

For each reference be sure to list their full name, relationship to you and e-mail and/or phone number.
First Reference*
Second Reference*
Third Reference*
One more thing. We want to know what your everyday life is like!

Please come up with a creative way to tell us what you typically do at 10 PM on a Saturday night. You can draw/create a picture or make a short video and send it to shona@theserviceboard.org with your name in the subject line. OR you can write a poem or other creative description (song lyrics, etc.) in the space below- whichever you prefer! Your application will not be considered complete till we have received this creative part of your application :)
Box for written materials if choosing this option!
Should be Empty:

2022 tSB Core Program Application (Prophet)

Questions? Contact Us!

Basic Information

Household Information

Short Medical History

Essay Questions

These next questions check what fits best for you.

Education

Employment

Community

Adventure

Please select a sliding scale payment option

Please provide three references. Your references may be friends, neighbors, teachers, employers or family members.

One more thing. We want to know what your everyday life is like!