Design to Better [Our Community] Summer Academy
Student Application - Summer 2018

For full program details, please visit: www.creativereactionlab.com/design-to-better-our-community/

A PDF version of the application is available for viewing here: http://bit.ly/2Ax3iAU

We encourage you to view the questions and prepare your answers, but ask that you use this online form to submit. 

Applications are due on February 5, 2018 at 11:59 PM CST.

If you have any questions about the program, please contact Erika Harano at eharano@creativereactionlab.com.
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PART 1: THE BASICS

 
What is your name? *

 
What are your pronouns? *

e.g. he/him, she/her, they/them, ze/zir
 
What is your street address? *

 
What city do you live in? *

 
Which state do you live in? *


 
What is your zip code? *

 
What is your phone number? *

 
What high school do you attend? *

 
What is your expected graduation year? *


 
What is your cumulative GPA? *

This program does not have a minimum GPA requirement. We see value beyond academic grades, so be honest!
 
What is your race/ethnicity? *

 
What is your gender identity? *

 

If you are not Black or Latinx, but are interested in participating in the program, please share why: *

 
Parent/guardian name: *

 
Parent/guardian phone number: *

 
Parent/guardian email address: *

 
PART 2: INTEREST, SKILLS, AND EXPERIENCE

 
Why do you want to participate in the Design to Better [Our Community] Summer Academy? (300 word limit) *

 
Please complete the following sentence:  I will make my city better by ______________________. Then, please tell us why. *

As part of our Community Design Apprenticeship Program, we ask all participants to take a pledge to commit to bringing about change.
 
Now that you’ve shared your ideas for change in your community. Share what has stopped you from trying some of these ideas. What are some obstacles you feel you would have to overcome to create change in your city? (300 word limit) *

 
Tell us about a time when you demonstrated leadership skills. (Keep in mind that these experiences don’t have to be formal. Did you lead a component of a school project? Have you mentored local youth in your neighborhood?) (300 word limit) *

 
How comfortable are you with the following topics and terms?

 
Entrepreneurship *


 
Creative Problem Solving *


 
Civic Engagement and/or Leadership *


 
Cultural History and Healing (specific to African American/Black and/or Latinx culture) *


 
PART 3: WRAPPING UP

 
Reference #1: Please provide the name and contact information (email and/or phone number) of an adult that can speak on your character and professionalism. *

The adult reference can be a professor, mentor, dean, supervisor (including former), community leader, religious center leader, etc.
 
Reference #2 (OPTIONAL): Please provide the name and contact information (email and/or phone number) of an adult that can speak on your character and professionalism.

The adult reference can be a professor, mentor, dean, supervisor (including former), community leader, religious center leader, etc.
 
Reference #3 (OPTIONAL): Please provide the name and contact information (email and/or phone number) of an adult that can speak on your character and professionalism.

The adult reference can be a professor, mentor, dean, supervisor (including former), community leader, religious center leader, etc.
 
How did you hear about this program? *

 
Is there anything else you would like to share, or questions you have for us?

Thanks! We will review your application and be in touch with you shortly.
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