Eco-Gap Application Form
Your Personal Information
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Your Street Address *
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Your City, Country and Zip Code *
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Your Phone Number *
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What is your gender or pronoun preference? *
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What is your birthdate? *
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Your Interests
What are your current interests and passions? What captivates you? (about 100-250 words) *
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The Eco-Gap program will explore issues concerning sustainable living and social justice - on a personal and global scale. What are some of your interests in these realms and which you'd like to explore more deeply? (100-250 words)
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Are you especially interested in any of the following? *
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Are you especially interested in any of the following? *
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We are looking for a diverse group of young adults to help us co-create the first Eco-Gap Program. Please tell us about your personal, educational, work (if any), volunteering, and/or organizing background. Tell us how you bring a unique perspective. What makes you stand out? We want to know! (about 100-250 words) *
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REFERENCES: Please provide us with the name of 2 references we can contact to get a better sense of who you are. These should be adults who have known you for some time such as teachers, bosses, volunteer coordinators, mentors, therapists, friends of your parents, etc. Please do NOT list your parents.
We recommend that you tell these references that we may be contacting them soon and that you let them know about Eco-Gap and your plans.
First and Last Name of Reference #1: *
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Email Address of Reference #1: *
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First and Last Name of Reference #2: *
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Email Address of Reference #2: *
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SCHOLARSHIP FUNDS
We will have limited scholarship funds available to help those who are most in need. Would you like to request any scholarship funds to offset the costs of Eco-Gap? If so, please tell us about your personal financial situation and how much funding you'd like to request. Please talk to your legal guardians about this. We will follow up with more questions.
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Lastly ...
How or where or from whom did you learn about Eco-Gap? (Please be as specific as possible.) *
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Is there anything else you'd like us to know about you?
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