Dream Summer 2015 Application

DREAM SUMMER 2015 APPLICATION

SECTION 1: PERSONAL INFORMATION If selected, this information will be used for travel arrangements and mailing purposes.

First Name (as it appears on your government/state issued ID)✻

Ex: JANE (Foreign passports are acceptable forms of government issued ID)

Middle Name (as it appears on your government/state issued ID) ✻

Ex: JUNE (Foreign passports are acceptable forms of government issued ID)

Last Name(s) (as it appears on your government/state issued ID)✻

Ex: DOE (Foreign passports are acceptable forms of government issued ID)

Date of Birth✻

Month / Day / Year

Sex (as displayed on your government/state issued ID)✻

Male
Female

Mark “X” on the option that best applies to you✻

I have been issued a Social Security Number authorized to work by the Social Security Administration
I have been issued an Individual Tax Identification Number (ITIN) by the IRS
None of the above
Prefer not to answer

ITIN Information

IMPORTANT: Your response will NOT affect your acceptance to Dream Summer.

If you have a work permit, you MUST select the SSN option. If you have both a SSN and an ITIN, mark the SSN option. If you have a work permit, you MUST provide your SSN, not an ITIN.

What is an ITIN?

Mark “X” on the option that best applies to you.✻

I qualify for DACA (Deferred Action for Childhood Arrivals program)
I qualify for DAPA (Deferred Action for Parental Accountability program)
None of the above
Not sure
Prefer not to answer

DACA/DAPA information

IMPORTANT: Your response will NOT affect your acceptance to Dream Summer.
What is DACA?
What is DAPA?

Best Phone Number✻

Ex: XXX-XXX-XXXX

Alternate Phone Number✻

Ex: XXX-XXX-XXXX

Email✻
Email(reentry ✻

Summer 2015 Address

Provide your housing address for summer 2015.

Reminder: Dream Summer does NOT provide housing or reimbursement for housing for the summer.

Street✻

Ex: 675 S PARK VIEW STREET APT 4

City✻

Ex: LOS ANGELES

State✻

Ex: CALIFORNIA

Zip Code✻

Ex: 90057

Permanent Address

Provide your permanent mailing address where it is safe to send important documents. If this address is the same as your "Summer 2015 Address" - retype it.

Street✻

Ex: 675 S PARK VIEW STREET APT 4

City✻

Ex: LOS ANGELES

State✻

Ex: CALIFORNIA

Zip Code✻

Ex: 90057

Mark “X” on your primary mode of transportation.✻

Private Vehicle
Public Transportation
Bike
Other

Dream Summer does NOT provide funding or reimbursement for transportation to and from the internship location.

If you marked other for primary mode of transportation, please explain.✻

SECTION 2: EDUCATIONAL INFORMATION

Mark “X” on your highest level of education completed as of June 15, 2015✻

IMPORTANT: Dream Summer does NOT have a level of education requirement. Your response will NOT affect your acceptance to Dream Summer.

NO HIGH SCHOOL DIPLOMA OR GED
HIGH SCHOOL DIPLOMA OR GED
ASSOCIATE DEGREE CANDIDATE
ASSOCIATE DEGREE
BACHELORS CANDIDATE
BACHELORS DEGREE
MASTERS CANDIDATE
MASTERS GRADUATE
P.h.D CANDIDATE
P.h.D GRADUATE
PROFESSIONAL DEGREE
OTHER

Are you a current University of California student and/or employee?*Mark “X” on your response.✻

YES
NO

Note: By "current", we mean if you were enrolled / employed or plan to be in 2015. Your response will NOT affect your acceptance.

Full name of current school or last school you attended.✻

Example: University of California, Los Angeles (UCLA)

Majors(s) / Minor(s) if applicableEx: Sociology✻

Graduation Date/Expected Graduation Date✻

Month / Day / Year

IMPORTANT: Dream Summer does NOT have a graduation requirement. Your response will NOT affect your acceptance to Dream Summer.

SECTION 3: INTERNSHIP PLACEMENT INFORMATION

Which city are you applying for?✻Mark “X” on Your Response.

Arvin, CA
Bakersfield, CA
Fresno, CA
Brookly, NY
Long Beach, CA
Los Angeles, CA
Manhattan, NY
Miami, FL
Oakland, CA
Pomona, CA
Queenss, NY
Sacramento, CA
Santa Ana, CA
San Bernardino, CA
San Diego, CA
San Francisco, CA
The Bronx, NY
Washington, DC
Santa Ana, CA
Not Listed ( Name the City Below)

IMPORTANT: Select the city based on the address you provided for summer 2015. Keep in mind that you will be expected to live within daily commuting distance of your internship placement. Dream Summer and participating host organizations do NOT provide relocation assistance nor transportation reimbursement for daily travel to and from the internship site.

If you marked “not listed” for cities, please listbelow. (Listing will not guarantee Internship placement in that city)

What is your relationship and connection to the city/region you are applying to? (100 words max)✻

Is there a second city you would like to apply for? If so, enter the name of the city from the list provided above. OPTIONAL

If you marked “not listed” for cities, please listbelow. (Listing will not guarantee Internship placement in that city)

What is your relationship and connection to the second city/region you are applying to? OPTIONAL (100 words max)

IMPORTANT: If applicable, select a second city based on an alternate location you may live in during summer 2015. Keep in mind that you will be expected to live within daily commuting distance of your internship placement. Dream Summer and participating host organizations do NOT provide relocation assistance nor transportation reimbursement for daily travel to and from the internship site.

SECTION 4: APPLICANT SKILLS, TALENTS AND INTERESTS

Language fluency (other than English)✻

Elaborate on your level of fluency in language(s) identified above.✻

Are you able to speak, write, and/or read in the language(s) previously indicated? Is it conversational or academic language proficiency? Are you a native speaker?

SKILLS, TALENTS AND INTERESTS

Please rate the skill level in all the areas below according to your knowledge and expertise. Mark “X” on Your Responses.

Rating system: 0 to 3, zero for not applicable and 3 for being highly knowledgeable. *

IMPORTANT: This information will be used to match you with an appropriate internship placement.

Creative Skills✻ (0 for not applicable and 3 for being highly knowledgeable.)Mark “X” on Your Response.

Skills / 0 / 1 / 2 / 3
Art Creation (Ex: muralist, painter, etc.)
Performance Art (Ex: Theater, etc.)
Photography

Communication Skills✻ (0 for not applicable and 3 for being highly knowledgeable.)Mark “X” on Your Response.

Skills / 0 / 1 / 2 / 3
Language Interpretation
Public Speaking
Strong Writing Skills
Workshop Facilitation

Organizational Skills✻(0 for not applicable and 3 for being highly knowledgeable.)Mark “X” on Your Response.

Skills / 0 / 1 / 2 / 3
Budget Management
Curriculum Development
Data Analysis
Data Entry
Event Planning
Grant Writing
Outreach and Recruitment
Research
Strategic Planning

Media and Design Skills✻(0 for not applicable and 3 for being highly knowledgeable.)Mark “X” on Your Response.

Skills / 0 / 1 / 2 / 3
Graphic Design
Social Media
Video Editing
Web Design

Enter any other skills that were not listed above:

Select the skills you rated as a 3 above. In the space below describe how you have developed these skills (150 words max)✻

Mark “X” on THREEskills you wish to develop during Dream Summer 2015.✻

Art Creation (Ex: muralist, painter, etc)
Budget Management
Curriculum Development
Data Analysis
Data Entry
Event Logistics
Grant Writing
Graphic Design
Language Interpretation
Public Speaking
Social Media
Strong Writing Skills
Video Editing
Web Design
Other (enter information below)

Explain why you want to develop the skills identified above.✻

Mark“X” on THREE social justice issues you wish to engage in during Dream Summer 2015.✻

Education
Health
Immigrant Rights
Labor/Worker Rights
LGBTQ Rights
Mass Incarceration and Deportations
Racial Justice
Reproductive Justice
Restorative Justice
Transformative Justice
Other (enter information below)

Explain why you wish to engage in these social justice issues✻

Mark “X” onTHREE areas of work you wish to engage in during Dream Summer 2015.✻

Community Outreach
Event Coordination
Fundraising
Grassroots Direct Organizing
Interfaith Organizing
Legal
Media
Policy Analysis
Research
Leadership Development
Other (enter information below)

Explain why you want to engage in these areas of work.✻

Healthy California Cohort

Healthy California interns work on projects that address the connections between health and immigrant rights. Selected interns lead projects on immigrant wellness and healthcare access for undocumented and uninsured Californians. For more information visit:

Would you like to participate in the Healthy California Cohort of Dream Summer?✻Mark “X” on Your Response.

Yes
No
More Information

IMPORTANT: Your response will NOT affect your acceptance to Dream Summer.

Are you a Dream.us scholar?Mark an X on the answer of your choice✻

Yes
No

IMPORTANT: Your response will NOT affect your acceptance to Dream Summer.

Are you a College Track scholar?Mark an X on the answer of your choice✻

Yes
No

IMPORTANT: Your response will NOT affect your acceptance to Dream Summer.

SECTION 5: ADDITIONAL INFORMATION

PURPOSE: Answers will NOT affect your acceptance to Dream Summer. Data retrieved from this survey will remain anonymous and is for statistical purposes only.

How do you identify? Please mark an X on all that apply.✻

African
African American
Arab
Asian
Asian Pacific Islander
Caribbean
Caucasian
Chicana/o
Hispanic
Indigenous
Latina/o
Middle Eastern
Native American
Southwest Asian
Not Listed
Other

If you marked "other," please explain.

Country of Origin✻

EX: Phillipines

How do you identify?Mark an X on all that apply

Female
Gender Non-Conforming
Intersex
Male
Not Listed
Other

How do you identify?Mark an X on all that apply

Bisexual
Fluid
Gay
Gender Non-Conforming
Lesbian
Queer
Transgender
Not Listed
Other

Preferred Gender Pronoun

Ex: Her, She, He, Him, They, Them, etc...

Do you have a preferred name you would like to be addressed as other than the name listed on your government issued I.D?

Is there anything else you would like to share about your identity? OPTIONAL

SECTION 6: DOCUMENT Attachments

You will need to email the following documents:

1)Essay Prompts A, B and C

2)Resume

3)Letterof Recommendation

4)Optionaldocument showcasing your talent (flyer, curriculum, photo, essay, etc.)

PROMPT INSTRUCTIONS

Submit your responses to prompts A, B and C in ONE document (PDF preferred but Word is also acceptable). Remember to proofread your document for any spelling and grammar errors before submitting.

Prompt A

Why are you applying to Dream Summer? How will your participation in Dream Summer support your leadership and professional growth? 350-400 words.

Prompt B

How have your identities impacted your life experiences and shaped who you are? Examples of what to consider: gender, class, sexual orientation, ethnicity, ability, religion and anything else that you believe contributes to who you are. 350-400 words.

Prompt C

What is your personal connection to the immigrant rights struggle? How has immigration affected you personally, your family, your community, your loved ones, etc.? 350-400 words.

Is there anything else you would like to share with the Dream Summer 2015 Selection committee?

How did you find out about Dream Summer?Mark an X on all that apply✻

Dream Summer Alumni
Dream.us
Community Organization
Facebook
Mailchimp Email
Presentation
School Advisor
Twitter
Website
Other

If you marked "other," please explain.

THANK YOU FOR COMPLETING THIS APPLICATION.

SUBMISSION GUIDELINES:

Complete and save this application
Complete Essay Prompts in a ONE separate Document (Word or PDF file)
Email the below documents to

1) Essay Prompts

2) Resume

3) Letter of Recommendation

4) Optionalsupplementary document

The subject e-mail title should read: Your Name DS 2015 Application

Example: Laura Flores DS 2015 Application