Globetrotter Student Application - Guilford County

Student Contact Information

  1. Full Legal Name:
  2. Nickname:
  3. Email Address:    
  4. Please check this box if the email address above is your personal email address:
  5. Home Phone Number:
  6. Cell Phone Number:
  7. What is the best way to reach you?
  8. Do you text?
  9. Parent's Name
  10. Parent's Cell Number
  11. Parent's Email

Biographical Information

 

  1. High School:
  2. Grade in School:
  3. Birth Date (YYYY/MM/DD):
  4. Approximate Annual Family Income:
  5. What type of financial assistance will you need to go on this trip?
  6. How many people are currently living in your household?
  7. Have you ever traveled outside the United States before?
  8. If so, where?
  9. Apx. how many days of school did you miss during the 2015-2016 school year?
  10. Portions of the Globetrotter experience can involve strenuous work and exercise. Recognizing this, please note any health issues or concerns that might need to be managed/planned for accordingly. (If there are none, please note "n/a" in your response.)
  11. Will you be able to manage transportation to and from Globetrotter team meetings/activities?
  12. Do you know how to swim? (This is not a requirement for selection.)
  13. Please list any extra-curricular activities with which you are currently involved.

Character Questions

 

How would you classify your ability to work with others? (Please check the one box that best applies.)

 I thrive in team environments.

 It is sometimes difficult for me to work in team environments, but I do well at adjusting in order to contribute to the well-being of the group.

 I often struggle working in team environments.

Please share a specific, real-life experience that helps to clarify your response to the "classification" question posed above.

In what ways would you like to grow/mature in the next 6-12 months?

Tell us about a time when you were faced with a daunting challenge, and what you did to deal with/overcome that challenge.

Using SIX words or less, tell us why you want to be a part of the GreenHouse Globetrotter Program.

Chose the one trait (out of each of the pairings listed below) that best describes your personality.

 Introverted
 Extroverted

 Analytical
 Emotional

 Learn best by DOING
 Learn best by WATCHING

 Adventurous
 Reserved/Cautious

 Spontaneous
 Calculated

 Organized
 Scattered

 Practical
 Idealistic


Please list any skills, experiences and/or character traits that you feel you possess and that could be of benefit to a Globetrotter team.



How many Service Hours have you booked to date? 

 

On a scale of 1-5 (5 being very comfortable and 1 being very uncomfortable), how would you rate your level of comfort living and playing in outdoor environments.


Student Agreement

 If selected, I understand that I will be expected to get a passport and immunizations in accordance with program requirements and expectations (which includes meeting deadlines in a timely manner and raising funds to cover applicable costs), and that by neglecting to do so would result in me forfeiting my position on the team.  

 If selected, I understand that I am expected to help lead the Service Learning at my school for the next two years, become a Service Learning Ambassador, attend weekly team meetings and participate in related leadership training, fundraising and other service learning activities, and that by neglecting to do so would result in me forfeiting my position on the team.

 If selected, I understand I would be acting as a representative of Dustin's GreenHouse, and thereby would make a conscious and consistent effort to ensure my actions and behaviors in no way jeopardized the safety of the group or the reputation of the school, Dustin's Greenhouse or myself.


Please name the person(s) who has submitted (or will be submitting) a nomination on your behalf:


Signature: Please initial to indicate your agreement with and understanding of the "Applicant/Scholar Requirements" and  to verify that the information provided in this application offers an honest depiction of your biographical and personal character.