Thank you for your interest in a summer internship with Newark Youth Leadership Project (NYLP), a program of Greater Newark Conservancy. As you know, this is not just a job, but an internship program designed to provide interesting and thought provoking opportunities in education and leadership with a focus on the environment. Please review the following details before considering your application to the program:         This application is for SUMMER 2015. This program will run from July 6, 2015 through August 14, 2015. You will be expected to be in attendance every Monday through Friday. Attendance is mandatory; there are no vacation days. If you are sick you must get a doctor’s note. NYLP is a leadership program that will focus on environmental issues including green jobs, the environment, healthy living, education and career exploration. In this program you will be pushed to try new things, experience outdoor activities and lead a healthier lifestyle. Requirements for the program are as follows: o Must be a Newark resident , but can be attending any high school o Must maintain a 2.5 or better GPA (most recent report card must be submitted) o Must have a recommendation of Guidance Counselor or teacher o Must have completed freshman year of High School at any high school Interns are paid $8.25/hr and will work up to thirty hours per week from July 6, 2015 through August 14, 2015. (which means they are paid up to 20 hours/week by the City of Newark NYOSCC AND paid up to 10 hours by Greater Newark Conservancy) Before being hired, each applicant will be screened through an interview process. Be prepared for this interview—dress for success and don’t be late! Selection is limited, and we always receive more applicants than we can accept so please submit this application as soon as possible. Interviews will begin in November. If you previously participated in summer or school year NYLP, a resume is required with the application! Should you have any questions about the application of the program, please feel free to contact me. We look forward to receiving your completed application! Sincerely, Emmanuela Mujica NYLP Coordinator 32 Prince Street Newark NJ 07103 Phone: (973)642-4646 Fax: (973)642-2218 SECTION 1 Contact Information Last Name First Name M.I. Street Address City, State, Zip Date of Birth Email Address Home Phone Cell Phone Emergency Contact Emergency Phone Best Time to Call Education School, City From To Major Expected Date of Graduation Please list all extracurricular activities you are involved with: Previous Employers or Programs (start with most recent) From To Employer City, State Phone Work Title Supervisor’s Name Starting Salary/Wages From Final Salary/Wages To Employer City, State Phone Work Title 32 Prince Street Newark NJ 07103 Phone: (973)642-4646 Fax: (973)642-2218 Supervisor’s Name Starting Salary/Wages Final Salary/Wages What is your T Shirt size? Small Medium Large  X Large  XX Large Have you participated in the Newark Youth Leadership Project before?  Yes  No If yes, please check which agency below:  Greater Newark Conservancy  New Community Corporation  La Casa De Don Pedro Why do you want to participate in NYLP? Please list your top three reasons. 1-___________________________________________________________________________________ 2-___________________________________________________________________________________ 3-___________________________________________________________________________________ Do you have any physical limitations that would prevent you from working outside during extremely warm or extremely cold weather? If so, please explain. Do you have any reservations about working on a farm, learning and researching environmental issues, and teaching others (children, community members, family, etc.) about the environment? _____________________________________________________________________________________ List three things that you would like to learn about by participating in NYLP? _______________________ Please read the following department descriptions and rank them in order of preference, 1-6. Horticulture: learn about gardening, plant flowers/veggies, water or weed gardens; outdoor work Greening: help beautify Newark, plant flowers, plan an event, start a community garden, outreach to local community; indoor and outdoor work, interaction with adults and students in and around Newark Education: learn about the environment and then teach others about it; outdoor work, heavy interaction with young children Farm Stand: learn how to run your own business by operating a farm stand & selling fresh produce, market and sell your product; visit a local farm; mostly outdoor work, interaction with adults and children in the local community Media: learn about creating a social media blog and maintain daily and weekly through writing assignments, interviewing people and editing videos on software to upload to the website Tree Farm: learn about landscape design and tree identification. You will plant, water and feed young trees and saplings and be a part of the city’s tree inventory project. Rank, from 1-6, in order of preference, 1 being the most interested, 2, second most interested, etc, and 6 being the least interested. (NOTE: You should have all numbers, 1 thru 6 in your ranking) Horticulture Farmer’s Market Community Greening  Media  Education Tree Farm 32 Prince Street Newark NJ 07103 Phone: (973)642-4646 Fax: (973)642-2218 ***ESSAY QUESTION: Please explain what you learned from this past summer and why you would like to participate in the Newark Youth Leadership Project during the school year. Please type your essay on another sheet of paper OR EMAIL YOUR ESSAY TO EMUJICA@CITYBLOOM.ORG *** APPLICANT’S STATEMENT I certify that the statements made by me on this form are true and correct. I understand that if I become a participant in the Newark Youth Leadership Project, any false statement on this application can be considered cause for dismissal. I am a naturalized citizen or have proof of my eligibility. I authorize investigation of all statements contained in application for participation as may be necessary in arriving at a decision for participation. I have read and understand the informational letter attached to this application.  YES  NO Signature of Applicant_____________________________________________________Date_________ PARENT’S/GUARDIAN’S STATEMENT I certify that the statements made by my son/daughter on this form are true and correct. If my child becomes a participant in the NYLP, I will support him/her fully. I understand that any false statement on this application can be cause for dismissal. Signature of Parent/Guardian_______________________________________________Date_________ A COPY OF THE APPLICANT’S REPORT CARD MUST BE INCLUDED WITH THE COMPLETED APPLICATION! THIS APPLICATION IS FIVE PAGES LONG—ALL PAGES MUST BE COMPLETED, INCLUDING THE ESSAY PORTION. THE APPLICATION WILL NOT BE CONSIDERED IS NOT FILLED OUT COMPLETELY AND ACCURATELY! THIS APPLICATION WILL NOT BE CONSIDERED IF NOT FILLED OUT COMPLETELY AND ACCURATELY! APPLICANTS WILL BE INTERVIEWED & ACCEPTED ON A ROLLING BASIS, MEANING THE SOONER YOUR APPLICATION IS TURNED IN, THE BETTER. INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED. DO NOT LOSE THIS APPLICATION. DUPLICATES WILL NOT BE SENT. Please send completed application to: Greater Newark Conservancy 32 Prince Street Newark, NJ 07103 Attention: Emmanuela Mujica FAX to: 973-642-2218 EMAIL to: emujica@citybloom.org 32 Prince Street Newark NJ 07103 Phone: (973)642-4646 Fax: (973)642-2218 SECTION 2 SCHOOL YEAR INTERNSHIP THIS SECTION IS FOR THE SCHOOL GUIDANCE OR SCHOOLS TO CAREER COUNSELOR TO COMPLETE. Student’s Name________________________________________________________________________ Grade_________________________ Name of Guidance Counselor_____________________________________________________________ Phone Number___________________ Fax Number ____________________Email__________________ Student Eligibility (Circle One) Meets Grade Average of 2.5/B Average? Resident of Newark? Will complete and pass first (freshman) year in High School by June 2015? YES YES YES NO NO NO Please check the following qualities that this student possesses: _____Attendance/Punctuality _____Creativity _____Outspoken _____Appearance _____Hygiene _____Reliability _____Dependability List Student’s Strengths List Student’s Weaknesses ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ Please sum up your recommendation of the student in two or three sentences. (Please print legibly) __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ _______ Signature_____________________________________________________Date____________________ 32 Prince Street Newark NJ 07103 Phone: (973)642-4646 Fax: (973)642-2218 A COPY OF THE APPLICANT’S MOST RECENT REPORT CARD MUST BE INCLUDED WITH THE COMPLETED APPLICATION! THIS APPLICATION WILL NOT BE CONSIDERED IF NOT FILLED OUT COMPLETELY AND ACCURATELY! APPLICANTS WILL BE INTERVIEWED & ACCEPTED ON A ROLLING BASIS, MEANING THE SOONER YOUR APPLICATION IS TURNED IN, THE BETTER. INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED. DO NOT LOSE THIS APPLICATION. DUPLICATES WILL NOT BE SENT. Please send completed portion to: Greater Newark Conservancy 32 Prince Street Newark, NJ 07103 Attention: Emmanuela Mujica FAX to: 973-642-2218 EMAIL to: emujica@citybloom.org 32 Prince Street Newark NJ 07103 Phone: (973)642-4646 Fax: (973)642-2218