Individual Application

PERSONAL INFORMATION:

______

First Name Middle Name Last Name

______

Street Address City StateZip

(___)______/ ___ / ______

Phone Number Date of Birth E-mail

Emergency Contact:

______(___)______

Name Phone NumberRelationship

Volunteering with TREATY:

___ / ___ / ______/ ___ / ___ --Your dates may change,

Arrival Date Departure Datebut give us your best guess.

Will you be driving to Pine Ridge? If not, please indicate your arrival time and airline/bus information so we can arrange transportation for you from Rapid City. The airport is 80 miles from Porcupine. We can supply ground transportation, though we request $50roundtrip to assist us with fuel costs.

Arrival Airline: ______Flight #: ______

Airline/Greyhound Arrival Time: ______

If you are driving, will you be bringing a vehicle that can be used for TREATY School projects? Y/N

If you would like local lodging (18 miles from Porcupine), contact Lakota Prairie Resort at 605-455-2555. The Prairie Wind Casino hotel is 55 miles from Porcupine.

Are you committed to assisting with day-to-day communal living operations such as cooking and cleaning? Y/N

Please indicate Project Area(s) you have experience with BOLD type:

  • Construction/General Contracting/Carpentry
  • Construction/Masonry
  • Heavy Equipment Operator/Heavy Labor
  • Painting/Drywall
  • Electrical
  • Renewable Energy – Fabricator
  • Mold Treatment
  • Plumbing
  • Architect
  • Cooking for Groups of up to 15 people
  • Administration/Office Mailing/Fundraising
  • Transportation/Driving
  • Agriculture – Greenhouse Construction
  • Agriculture – Permaculture/Horticulture
  • Ranch labor/Fencing/Animal Husbandry
  • Other: (please be specific) ______

In a paragraph please describe your skills and experience in the area(s) you indicated:

Please indicate any tools or materials that you will be bringing with you:

LOGISTICS:

Please answer yes or no to the following questions:

If you would like school credit for an internship, please provide documentation.

Do you have any health concerns we should know about? Y/N

If yes, please explain: ______

Have you ever been arrested? Y/N

If yes, please explain: ______

FINANCES:

Short term volunteers (those working with us for 1 day to 1 month) are asked to donate $10 per day to help offset the cost of food, transportation & materials.

I can make a personal financial commitment of: $______.

Volunteers are encouraged to do additional fundraising to support the work of The TREATY School. We encourage you to set a pre-trip personal fundraising goal now. Fundraising events can include screenings of films about Pine Ridge Indian Reservation, Guest speakers, Radio Show Hosting and others. Let those you know understand why you’re headed to Pine Ridge. Be Creative and let us know how we can help!

Before my trip I will raise:

$______for building materials and supplies

$______for volunteer transportation

$______for volunteer food supplies

By volunteering for, and participating in this project, I acknowledgethat I will be working in a remote region with limited medicalinfrastructure AND that the construction work involved is inherentlydangerous. Further, I agree that I will be personally responsible forbringing protective equipment with me such as safety glasses, hard hat,and suitable work boots and gloves. Lastly, I acknowledge that Iwill be fully responsible for any medical expenses which I may incurregardless of cause.

In submitting this application I certify that information contained in this application is true and complete to the best of my knowledge. I understand that false information may be grounds for immediate termination of my volunteer position. I authorize the verification of any or all information listed above.

Please Sign Here:

Print Name:Date:

Please attach the following documents to this application:

1) Your resume - 2) The contact information for up to 3 references

3) One page or less telling us a bit about; how you decided to apply to TREATY School, what you would like to accomplish in your time volunteering and what you expect us to provide for you as a volunteer.

Note: A copy of your picture ID or passport is required upon arrival.

PLEASE ALLOW TWO WEEKS FOR A RESPONSE!

Thanks for taking the time to tell us about your-self. We will be in touch!