Community Learning and Public Service
-Application-
Please check position(s) applying for (refer to attachment for details):
UNM Service Corps/AmeriCorps Volunteer/AmeriCorps
1. Name (First, MI, Last) Date
2. AddressCity/StateZip
3. Email Address______ Phone Number
4. SSN 5. Banner ID # (UNM Students)
6. Sex: male female 7. DOB:
8. Are you a U.S. citizen, U.S. naturalized citizen, or permanent resident? (AmeriCorps grant requirement) Yes No
9. How did you learn about this program?
10. Do you want your child/children to participate in the after-school/summer youth program? Yes No
If so, age(s) of your child/ children ______
11. Educational Background: Please list all schools attended. (Including high school or GED)
SchoolMajor/Focus Years Attended Degree/Diploma
______
______
______
______
12. Youth/Community Related Work Experience: Please briefly list and describe related employment.
Position OrganizationSupervisor PhoneDates
13. References: Please list three (3) references such as a teacher/professor, past employer, and/or a mature person who have known you for a number of years and can comment on your commitment and work habits (non-relatives):
NameAddressPhone Number
1)
2)
3)
Background:
- Have you ever been convicted of any felonies?Yes No
If yes, please describe in detail, including when and where (attach sheet if necessary):
2. Do you have a valid driver’s license? Yes No If yes, expiration date: ______
3. Are you work study qualified? Yes No If yes, amount (Federal/State): ______
4. Are you a full-time student Yes No
Skills Survey:
Please mark any areas in which you have skills, experiences, or educational background, regardless of its depth. Rate skills based on experience level 1-4 (1=no experience, 4=a lot of experience.) You are not necessarily expected to have skills in every area.
Skill Area (add comments for clarification if needed) Experience Rating
ADMINISTRATIVE
Writing reports Word processing Time management
Web page design
Planning
Email/Internet Communications
ART, DRAMA, MUSIC, DANCE
Drawing
Painting
Murals
Woodworking
Metalworking
Sculpture
Ceramics
Drama
Acting
Putting on plays
Singing
Storytelling
Playing a musical instrument
DancingOther:______
ENVIRONMENT
Sustainability issues in the Southwest
Knowledge of native plants & crops
Xeriscaping
Community gardens & agriculture
Water issues in the Southwest
New Mexican wildlife
Other:______
HISTORY
New Mexico
Local neighborhood
Oral history
Community history documentation
Other:______
Skill Area (add comments for clarification if needed) Experience Rating
LANGUAGE (other than English)
Specify language(s) Speaking
Specify language(s)Reading
Specify language(s) Writing
Other: ______
CULTURAL AWARENESS
Knowledge of your own history and cultural heritage
Knowledge of a culture other than your own
Experience working with a culture other than your own
Experience living with a culture other than your own
Experience communicating with a culture other than your own
Other:______
LEADERSHIP
Facilitation
Mentoring & tutoring skills
Leading discussion and reflection
Cooperative group games
Teambuilding activities
Teaching reading and writing
Other:______
COMMUNITY ORGANIZING
Coordinating community gatherings
Recruiting
Fundraising
Community Based Research
Door to door canvassing
PHOTOGRAPHY AND VIDEO
Camera experience(photos)
Camera experience (video)
Video production
Media literacy
Other:______
RECREATION
Health & fitness
Yoga
Tai chi
Running
Swimming
Camping
Hiking
Other:______
SCIENCE
Biology
Botany
Physics
Chemistry
Environmental research projects
Social
1 / 2 / 3 / 41 / 2 / 3 / 4
1 / 2 / 3 / 4
Computer science instruction
Health literacy
1 / 2 / 3 / 4Other:______
Academics: (Please list any academic strengths that you may have)
Other: (Hobbies, special interests, unique experiences, and other talents may be listed here)
Strengths:
Please list your top three (3) strengths from above listing or others
1. ______
2. ______
3. ______
Direct Experience:
1. Please describe and comment on any experiences you have had working with youth.
2. Please comment on any experience you have had working with community organizations or schools.
3. Tell us in 100 words or less why you want to be a part of this project. (on a separate piece of paper).
4. Prioritize the following from 1 (the one you are most interested in) to 7 (the one you are least interested in):
_____ Elementary school age youth leadership and community development
_____ Middle school age youth leadership and community development
_____ High school age youth leadership and community development
_____ Ethnic/cultural/racial youth leadership and community development
_____ Media/Arts/Technology
_____ Issues of health access
_____ Sustainable communities/environment
Don’t forget to Attach:
- Your written response to question #3 under direct experience
- A current letter of recommendation
- Your current semester class schedule (if you are a student)
Submit your application to any of the following drop-off sites,
If you have any questions contact our UNM office at (505) 277-9523 or
Email us at :
JohnMarshallMulti-ServiceCenter CentralNew MexicoCommunity College
Community Learning & Public Service2nd Floor of StudentServicesBuilding, Room 202
1500 Walter SE, Room 242 525 Buena Vista SE
Albuquerque, NM87102 Albuquerque, NM87106
Office: (505) 764-9523 Fax: (505) 764-3019
University of New Mexico
Community Learning & Public Service
College of Education-MSC05 3040
Manzanita Hall, Room 123
Albuquerque, NM87131
Office: (505) 277-9523 Fax: (505) 277-9123
Email:
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