Child Enrollment Form
Child Enrollment Form
Nia Cultural Center
Children's Defense Fund Freedom Schools ® 2017 Servant Leader Internship Application
Full Name (First, Middle, Last)
Date of Birth
Current Street Address
How did you find out about this service opportunity?
Are you a returning Servant Leader Intern?
If yes, how many summers have you served as a Servant Leader Intern in the CDF Freedom Schools program?
Were you enrolled in the CDF Freedom Schools program as a student?
If yes, indicate the number of years and CDF Freedom Schools site(s)
Do you currently live, or have you ever lived, in the community where this CDF Freedom Schools site is located?
School and Work Information
Highest Education Level Achieved: (check appropriate box)
Attending 2-year college
Attending 4-year college
College Graduate (2-yr.)
College Graduate (4-yr.)
Attending Graduate School
Year in School
Current Declared Major
2. College/University (if applicable)
Did you take any education or child development courses in college?
If yes, please list each education or child development course title and the semester the course was taken
Have you participated in any leadership development/training courses, classes, seminars, workshops, etc.?
If yes, list the content, date, and place of each training experience
If you have graduated, what is your current employment?
Work and Volunteer Information
Please list any experiences you have had working with children.
Please describe any work you have done in the area of youth leadership development. (please be specific)
Please list any volunteer and paid work you have done in your school, church, or community
What knowledge have you gained from your experiences in serving your school, church, or community?
Explain why you are interested in serving as a Servant Leader Intern at a CDF Freedom School's site?
What special skills or talents will you draw upon and incorporate in your work if selected to serve as a CDF Freedom Schools Servant Leader Intern?
What do you hope to gain as a result of serving at a CDF Freedom School's site?
Explain how you are able to contribute to the success of the program?
Are there any factors that will affect your ability to fully participate in all program activities?
2. Emergency Contact Person
Secondary Phone Number