Earth Mentor Program Application
Important Dates: We are currently welcoming applications for the 2008 Program. See the application schedule and payment due dates
Scholarships: A limited number of scholarships are available. Complete an On-line Scholarship Application (or download the Scholarship Application in pdf format, and mail it in).
Applicant Information
Fields marked with * are required
Applicant Name:
*First:
Middle:
*Last:
Contact Information
*Street:
Apt:
*City:
State:
*ZIP:
Country:
*Name:
*Email:
*Home Phone:
() -
Cell Phone:
() -
Please list any previous classes or training you have done with Wilderness Awareness School:
Please list any related programs you have taken with other organizations or individuals:
*What do you hope to gain through your participation in the Earth Mentoring Program?
Please provide two personal references we can contact. One can be a parent or close relative. Please choose people who know you well and who can speak to your suitability for the Earth Mentor Program and for working with youth.
Reference 1
*First:
*Last:
*Street:
Apt:
*City:
State: *ZIP:
Country:
*Name:
Email:
*Phone:
Daytime () - Evening () -
*Relationship:
Reference 2
*First:
*Last:
*Street:
Apt:
*City:
State: *ZIP:
Country:
*Name:
Email:
*Phone:
Daytime () - Evening () -
*Relationship:
Criminal Background Check: We run criminal background checks on all volunteers and mentoring students who work with our youth programs. We need your full legal name, date of birth and social security number to run the background check.
*Legal Name:
( Same as above) First: Middle: Last:
*Date of birth:
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*SS#:
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NOTE: You should receive an automatic email response confirming your form submission within a few minutes after clicking the submit button below. If you do not receive this email within an hour (be sure to check your "junk" folder), please resubmit the form information or contact our office, as we may not have received your application information. Wilderness Awareness School does not discriminate on the basis of race, color, religion, age, sex, disability, national or ethnic origin, or sexual orientation. Wilderness Awareness School is an Equal Opportunity Employer.