STUDENT ACTION

WI FARMWORKERS

2010 SSC Fellowship

Application

Instructions

This application form will be used by SAF to determine your eligibility, skills and interests for the program. You should prepare your personal statement and resume in separate word documents. The application components consist of:

(1) Completing this application form, an essay and resume;

(2) Completing the Spanish Language Evaluation form; and

(3) Paying the $20 application fee, either with your credit card at or by mailing it to SAF, 1317 W. Pettigrew St., Durham, NC 27705.

All application components must be completed electronically and submitted via email by Friday, February 12, 2010. WE WILL NOT ACCEPT APPLICATIONS BY MAIL OR FAX. Applications should be emailed to .

If you have questions or concerns about the application process, please contact Melanie Stratton Lopez at 919-660-3652 or .

Essay

Using 1-2 pages (250-500 words), explain your personal interest in, and qualifications for, working with farmworkers. Please attach your essay as a word document along with your application form. Save the file name using this format: First Initial dot Last Name Essay (example: L.Haynes Essay.doc) Be sure to answer the following questions:

  1. Why are you interested in participating in the farmworker movement?
  2. What related experience do you have that qualifies you to work with farmworkers and in a health capacity?
  3. Describe a time when you had to take initiative on a project and work independently. What did you enjoy about that experience and what was challenging?

Resume

Please attach a one-page personal resume listing your academic, work, and volunteer experience. Be sure to include relevant experience in the areas of health, social justice, activism, community service or community organizing. Include names, phone numbers and emails of two references. Include your name, current address, phone & email in the resume. Save the file name using this format: First Initial dot Last Name Resume (example: L.Haynes Resume.doc)

Spanish Language Evaluation

Please have a Spanish professor or professional evaluate your oral and written Spanish level using the Spanish Language Evaluation form available on SAF’s website. Native Spanish speakers do not have to complete this form.Save the file name using this format: First Initial dot Last Name Eval (example: L.Haynes Eval.doc)

Application Checklist

Use this checklist to make sure that you have completed the following required components of the SSC application process:

Application Form

Essay

Resume

Spanish Language Evaluation

I will pay the $20 application fee by mailing a check/money order payable to SAF

I will pay the $20 application fee online via

CAMP Students: You are required to pay the application fee, however your CAMP Program may cover the fee or reimburse you. Please discuss this directly with your CAMP Director. If they do not agree to pay, you are responsible for the application fee.

Sowing Seeds for Change Fellowship Application Form 2010 |

Sowing Seeds for Change Application Form

Personal Information

Name (as written on government issued ID):

Preferred Name:

Primary Address (where you would like to receive mailings):

City: State: Zip:

Secondary Address:

Secondary City: Secondary State: Secondary Zip:

Home Phone: Mobile Phone:

Email:

Racial/Ethnic Background. Check all that apply. (Optional)

Hispanic/Latino/Latin American/Chicano White/Caucasian Black/African American

Indigenous/Native American Asian (specify below) Other (specify below)

Use this space to specify how you identify your ethnic background. (Optional):

Gender (Optional): Female Male Trans, male spectrum Trans, female spectrum

Age: Date of birth (mm/dd/yy):

Member of a farmworker family? Yes No

If yes, describe the agriculture your family worked in and for how long.

Member of a College Assistance Migrant Program (CAMP)? Yes No

If you are a SAF Alum, please type the year and placement you worked with.

Education

College/University:

Year in School: Month & Year of Graduation:

Major(s): Career Goal:

Personal Assets & Skills

Check if you have experience in the following:

Public Speaking

Self-guided, work well independently

Organizing public events, protests or demonstrations

Mentoring youth

Teaching English as a Second Language

Teaching (explain)

Interpreting or translating (Spanish/English)

Health outreach experience

Health education experience

Documentary (using interviews, photography or film)

Theatrical performance

Other relevant skills

Do you have a valid driver’s license? Yes No

If yes, when was your license issued?

Do you have valid auto insurance? Yes No

Check all that apply to you:

Will have useof a reliable carfor the duration of the program June 1-November 19, 2010

Willing to drive my car to the 3 retreats in North Carolina

Willing to drive or travel long-distances for outreach (farmworkers may be located 1 or more hours from your office)

Willing to live in a rural community (some placements are in very small isolated towns with few entertainment options)

Would do well if placed without a partner fellow or intern (this may include living and working without a peer)

Willing to work primarily with meat processing workers or non-field workers

Willing to work evenings and weekends (outreach starts after farmworkers get off work, 5-11pm and/or on weekends)

Willing to work in an office setting at least half of the week (all placements have significant office hours to work on projects, prepare for outreach visits and record gathered information)

Interested in performing with the theater group

Interested in documenting farmworkers’ lives

Interested in submitting a proposal to fulfill an academic requirement in lieu of theater or documentary

Willing to fundraise a minimum of $650 to support SSC

Geographic Location

All fellow placements are in North Carolina. If you must be placed in a specific geographic area within NC please indicate where and why you must be placed there in the space below. We will try to meet your needs, but because of limited placements, we cannot guarantee you a placement in a specific area.

Please type the city or county you must be placed in and explain why you have made this decision:

Would you still be interested in and able to participate in the program if we are unable to place you in a specific geographic area?

Yes No Unsure

Interest in Into the Fields

If we can not offer you a fellowship position, would you be interested in a 10-week Into the Fields Internship position from June 1 - August 8, 2010?

Yes No

Thank you for applying to the Sowing Seeds for Change Fellowship Program!

Sowing Seeds for Change Fellowship Application Form 2010 |