Native American Health Center Youth  Services  Program  

Youth  Development  Fellowship  Application

____________ Date    ____________________________________________________________________________  First         Middle           Last    ___________________________________________________________________________________________  Address       City       State       Zip    ___________________________________________________________________________________________  Home  phone             Cell  phone    ___________________________________________________________________________________________  Date  of  Birth             Tribe/Ethnicity        ___________________________________________________________________________________________  Name    of  School                                                                              Grade    ___________________________________________________________________________________________  Address         City         State         Zip    ___________________________________________________________________________________________  Hobbies  and  Interests          Please  provide  two  references  (other  then  a  relative):      ___________________________________________________________________________________________  Name         Phone             Relationship    ___________________________________________________________________________________________  Name         Phone             Relationship    

           

Deadline: Wednesday May 25, 2011 by 5:00pm

 

Applicants-­‐‑  please  answer  the  following  questions  clearly  and  thoroughly  to  assist  us  in  understanding  your  goals  and  qualifications.  Remember  the  applications  process  is  very  competitive.  Many  of  the  following  questions  will  be  asked  when  applying  to  universities  &  scholarships.    Type  your  answers  and  submit  them  with  the  application.  Please  type  your  answers  on  separate  sheets  of  paper.      

The  following  8  questions  are  for  NEW  APPLICANTS:    

1. Youth   Fellows   participate   in   a   rigorous,   fast   paced   work   environment   where  meeting  deadlines  and  voicing  your  opinions  and  concerns  is  vital  for  success  of  the  program.  Give  an  example  of  a  significant  experience  that  illustrates  your  ability  to  adapt  to  this  pace  and  environment.  You  may  use  previous  experiences  from  past  involvement  in  sports,  school  or  in  the  community.  (Minimum  of  200  words)  

 2. What  would  you   like   to  do   after   high   school?  Where  do  you   see   yourself   in   five  

years?  How  will  this  Youth  Development  Fellowship  help  you  to  reach  your  goals?              (Minimum  of  250  words)    3. Name  3  issues  that  affect  you  and  your  community.  How  do  you  think  these  issues  

can  be  changed?    1. (Minimum  of  100  words)  2. (Minimum  of  100  words)  3. (Minimum  of  100  words)    4. Name   one   obstacle   you   have   had   to   overcome   as   a   young   person.   Describe.  (Minimum  of  100  words)  

 5.  If  you  could  pass  any  law  affecting  youth,  what  would  it  be  and  why?  (Minimum  of  100  words)    6.  What  is  an  accomplishment  you  are  most  proud  of?  (Minimum  of  50  words)    7.    Tell  us  about  a  talent,  experience,  contribution  or  personal  quality  you  will  bring  to        the  Fellowship.  (Minimum  of  50  words)    8.  Who  is  the  biggest  influence  in  your  life?  How  have  they  impacted  you?  (Minimum  of  50  words)    

 In  addition,  all  applicants  must  submit  a  professional  resume  of  past  work  experiences  and/or  volunteer  experience  this  includes  internships,  extra  curricular  activities  and  

community  involvement.    

If  you  have  participated  in  the  Fellowship  in  the  past  please  answer  the  following  10  questions:  

   

1.  What  have  you  learned  from  your  participation  in  the  past  fellowship  program?  How  do  you  plan  on  utilizing  those  skills  in  this  years  Fellowship?  Have  you  acquired  new  skills/knowledge/experiences  that  will  add  to  the  program,  if  so  what  are  they?    (Minimum  of  200  words)  

 2.     Since   your   participation   in   the   fellowship   how  have   you   stayed   active  within   the  community?  If  you  have  not,  why?  (Minimum  of  150  words)    3.     In   the   past   year  what   is   one   book   or   film   that   has   left   an   impact   on   you?  Why?  Would  you  recommend  other  youth  see  it  or  read  it?  (Minimum  of  50  words)    4.  What  topics  or  issues  would  you  like  to  see  covered  over  this  year’s  Fellowship?    (Minimum  of  50  words)    5. Give  an  example  of  a  time  you  have  voiced  your  opinion  to  stand  up  for  yourself  or  

someone  else.  What  was  the  outcome?    (Minimum  of  100  words)    

6.  What  are  your  current  short  term  goals  (within  the  next  two  years)?  How  can  the  Fellowship  help  you  meet  those  goals?    

7. Describe  the  world  you  come  from—for  example,  your  family,  community  or  school—and  tell  us  how  your  world  has  shaped  your  dreams  and  aspirations.  (Minimum  250  words)  

8. Write  about  an  experience/achievement  and  its  effect  on  you.  (Minimum  of  75  words)    

9. What  educational  activity  or  fieldtrip  would  you  suggest  for  the  youth  from  the  Summer  Program?      

10. Why  should  you  be  reconsidered  for  the  Fellowship?  (Minimum  of  50  words)      

 In  addition,  all  applicants  must  submit  a  professional  resume  of  past  work  

experiences  and/or  volunteer  experience  this  includes  internships,  extra  curricular  activities  and  community  involvement.  

 Your  application  can  be  mailed,  hand  delivered  to  Youth  Services  Drop  in  Center,  or  can  be  emailed  to  TahneeC@nativehealth.org.  For  more  information  and  any  questions,  please  contact  Tahnee  Camacho  at  the  number  provided  below.    

Native  American  Health  Center  Youth  Services  Program  3124  International  Blvd.    

(entrance  on  1st  Floor  on  the  corner  of  31st  Ave)  Oakland,  CA  94601  Phone:  (510)  434-­‐‑5330  Fax:  (510)  437-­‐‑9574  

       

Checklist    

q Answer  all  essay  questions  completely,  remember  the  word  counts.    

q Complete  application  with  2  references  (non-­‐‑relatives)  q Professional  Resume  q Remember  to  proof-­‐‑read  application,  essays,  and  resume  q Deadline  Wednesday  May  25,  2011  by  5:00  pm  

 Remember,  incomplete  or  late  applications  will  

not  be  accepted!