Village Amp: DOA Application
Please complete this form to be considered for acceptance to the Village Amp Digital Organizing Apprenticeship. The essay section is the most important part of the application, so we suggest you start there first.

If accepted, you will be expected to complete several other application components including a medical release form, transportation permission slip, media release form, report card release form, professional conduct agreement, and guardian agreement.
Applicant Information
Applicant Name *
Applicant Date of Birth *
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Applicant Email *
Applicant Home Phone Number *
Applicant Mobile Phone Number *
Academic Background
High Level of Education Completed *
Grade Level Completed by July 1st, 2015 *
College Name
High School Name
School for previous school year (if different from above)
References
Please provide the name and contact information of at least 1 person who is familiar with your work in an academic or work setting and who can speak to your ability to achieve in this apprenticeship.
Reference 1 - Name *
Reference 1 - Phone *
Reference 1 - E-mail *
Reference 2 - Name
Reference 2 - Phone
Reference 2 - Email
Parent/Family Information
Parent/Guardian Name
For applicants aged 17 years or less by July 1st, 2015
Guardian Mobile Number
Guardian E-mail *
Applicant Mailing Address *
Please include city, state, and zip code
Survey Information - Optional
Although the survey section is optional, we strongly encourage applicants to provide the information requested. It helps us to report to our funders to continue to provide free programs.
Parent Occupation
Annual Household Income
Does the applicant or family own a computer at home?
If yes, how many?
If not, has the applicant owned a computer at home?
What is the condition of the home computer(s)?
Does the family have access to internet at home?
Applicant Experience & Essays
This is your chance to tell us who you are and why you want to make a difference. Don't be shy!
Do you have experience producing content in any of the following formats? *
Please select all that apply
Required
If you have examples of your previous media projects online, we would love to see it! (Optional)
Please provide links separated by commas to any of your online content
What media skills would you like to develop during your time as an apprentice? Please explain how you will use these skills to create change. (150 words) *
Name 1 social issue that you would like to address this summer? Why is this issue important to you? (150 words) *
Who inspires you? Why? (2 sentences) *
I verify that I, the applicant, completed the Student Statement section of this application, and no one else.
Please type your name below as an esignature affirming that the above statement is true.
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