Yewths ROC

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Youth Volunteer Application

Eligibility Requirements

Before completing this application form, please read the following eligibility requirements and details:

Must be 12 years of age or older to apply
If under 15, must have a parent or chaperone accompany you on outreach trip
Must have prior involvement with YEWTHS ROC Program
Evidence of community or civic involvement
Leadership skills
Two Letters of Recommendation (including all contact information)
Be prepared for a personal interview with ROC staff members
Applicants must pay for their expenses associated with outreach trip

You must submit this completed application form and all supplementary sheets to ROC Wheels by October 1, 2010. Late applications will not be accepted. Selection will be based upon the essay, biography, and ROC volunteer history of applicant. Only 24 applicants will be selected to go on the Jamaica Spring Break Expedition that will take place in March of 2011. Semi-finalist will be notified to set up a personal interview by October 6, 2010. All finalists will be notified by October 15, 2010.

Essays

Please prepare the following documents with your name in the upper right-hand corner.

1. A brief autobiography, no longer than one page, introducing yourself (this will be used to introduce you to other students and volunteers on outreach trip).

2. A detailed statement of intent, no longer than 2 pages, describing:

Your reasons for applying to be a YEWTHS ROC Volunteer
Your strengths and what you hope to offer the ROC Team and the children affected by disabilities and their families (ex: your talents, gifts, character traits, etc.)
What you hope to gain from this YEWTHS ROC Volunteer experience

Letters of Recommendation

Applicants should have two academic instructors or appropriate mentors/employers/supervisors/pastors/etc. complete a letter of recommendation. You should inform the professionals writing the recommendation that they are writing a letter for the purpose of applying for the YEWTHS ROC Jamaica Spring Break Expedition.

ROC Wheels. 301 Gallatin Park Dr. Bozeman, Montana 59715. www.RocWheels.org. 406.556.8065.

Personal Information

06-Feb-12 01:02 AM

Outreach Destination:

Name (Last, Middle, First):

Address (Street, City, Zip):

Telephone number:

Email Address:

What is the best way to contact you?
Phone
Email
Other

Passport Number:

DOB (month/day/year): Citizenship:

Male
Female

School Attending:

T-Shirt Size:

Qualifications

How did you become familiar with ROC Wheels, Inc?:

Do you have any foreign language skills? What language(s)?

Academic achievements, volunteer experience and extracurricular activities:

Have you ever been on an international volunteer/missionary trip before? Where?

If so, what was your experience like?

Do you know of any reason that you may have difficulty functioning in a foreign country?

Have you ever been convicted of a felony? (This is solely for the ROC Wheels, Inc. staff)

Do you have any dietary restrictions? If so, please specify.

ROC Wheels is a Christian faith-based organization. Would you like to participate in any gatherings for prayer, music, or worship?

Will a parent or chaperone be going with you?

Yes
No

Name of parent or chaperone (this individual must submit a volunteer application):
Indemnity:
I/We do hereby agree to pay for any medical expenses incurred by said person(s) and to reimburse ROC Wheels, Inc. for any expenses incurred by it with respect to such expenses. I/We herby agree that I will not hold ROC Wheels, Inc., its staff, agents and volunteer responsible for any illness, injury, damage or loss incurred by said person(s) during the course of involvement with ROC Wheels’ YEWTHS ROC Program.

Signature of Applicant:_________________________________________

Date:____/____/____

If applicant is under 18 years of age, signature(s) of Parents/ Guardian is also required.

Signature(s) of Parents or Guardian:_________________________________

Date:____/____/____

Medical Information

Is there any medical or physical reason why you would have to restrict yourself from strenuous activity?

Do you have any allergies to food, medicine or the environment?

Emergency Contact

Name:

Relationship:

Address (Street, City, Zip):

Telephone number:

Email Address:

Your signature: __________________________________________________
(please print the next page after you submit and mail to the address listed below.

Date: 06-Feb-12 01:02 AM

Deadline: You must submit this completed application form and all supplementary sheets to ROC Wheels by October 1, 2010. Late applications will not be accepted.

Please mail or e-mail the completed application to:

ROC Wheels Inc.,
301 Gallatin Park Dr.
Bozeman, Montana 59715
holly@rocwheels.org

406 556 8065, fax: 406 556 8065, www.rocwheels.org, holly@rocwheels.org

Click button to go to PayPal secure site for credit card donations.
ROCWheel'ss tax ID number is 20-0402658

ROC Wheels, 301 Gallatin Park Dr , Bozeman, Montana 59715
www.RocWheels.org
Andrew Babcock, Executive Director, Andrew@ROCWheels.org
Phone/Fax #: 406.556.8065
ROC Wheels is a 501 (c ) (3) Non-profit Organization