Oak Park & River Forest High School • Holmes Elementary School
POWER OF PARTNERSHIPS
Elementary School Internship
SILC K-5 APPLICATION 2015-2016
Submit to Room 372A
I. Please complete the following information. Please print legibly.
Student Name _____________________________
Student Email Address _____________________________
The address you check every day!
Student Address ___________________________________________________________________________
Street
Village
Zip Code
Student Phone No. __________________________
OPRFHS ID Number ________________________ Counselor _____________________________________
I.

Select Options for Service
Circle your preferred two days to serve each week.
A. Holmes Elementary School
Hours of service: 3:30 p.m. - 5:00 p.m.

II.
Circle your requested semester:
M
FALL
T
W
TH
SPRING
Please answer the following questions thoughtfully. Please write your response legibly and in complete
sentences.
1. Explain why you want to participate in the SILC K-5 program. Your explanation should address what you hope to
gain from participating, as well as what you hope to offer as a participant.
2. Describe your personal strengths, qualities, or experiences that will make you an effective SILC K-5 participant.
You may address academic, personal, or interpersonal matters.
3. Without repeating what you have already written, please describe interests and talents you would be willing to
share with younger students as a SILC K-5 participant (academic, co-curricular, etc.).
Over, please
III.
Select Program Options: Check One
Option A (Seniors only), Elective Credit
I am or will be enrolled in the Business Community Service Internship course for the semester in which I will
participate in SILC K-5. I will complete all requirements of the course.
Option B, Volunteer Service
IV.
References (Forms attached.)
I have attached two references. At least one is from a current or former teacher of mine at OPRFHS. The
second reference may also be from a teacher or from a coach, teacher aide, tutor, or staff person with whom I
have worked at OPRFHS.
Student Signature: I have read the Program Description and understand and will abide by the requirements of
participation in the SILC K-5 program. I understand that I must provide my own transportation.
______________________________________
Signature
____________________
Date
Counselor Signature: I support this student’s application for the SILC K-5 program and will make necessary scheduling
arrangements to allow the student to participate.
______________________________________
Signature
____________________
Date
Parent/Guardian Signature: I have read the Program Description of the SILC K-5 program and reviewed my
son/daughter’s application, and I approve his/her participation in the SILC K-5 program. I understand that my
son/daughter must provide his/her own transportation.
______________________________________
Signature
____________________
Date
Oak Park & River Forest High School • Holmes Elementary School
POWER OF PARTNERSHIPS
Elementary School Internship
(SILC K-5)
Faculty/Staff Recommendation Form
Student’s Name_______________________ Faculty/Staff Member’s Name_________________________
The Power of Partnership/Senior Instructional Leader Corps Program (SILC K-5) is designed to offer interested
and qualified juniors and seniors the opportunity to work as a tutor/mentor to elementary school students at
Holmes Elementary. The above-named student is applying for the SILC K-5 program. Tutor/mentors are
expected to be exemplary role models and to demonstrate commitment to their own academic success. Your
input below will help us to select students who are both eager and able to fill the important role of tutor/mentor
for younger students.
 How long have you known this student and in what context? _______________________________
_______________________________________________________________________________________
 Please rate the student on each of the following characteristics:
Below
Average
Average
Good
(above
average)
Very Good
(well above
average)
Excellent
Work Ethic
Maturity
Motivation
Leadership
Integrity
Concern for others
Reliability
Self-confidence
Enthusiasm
Attendance
 Please share any other comments that will help us to evaluate this student’s readiness to work as a
tutor/mentor to younger students.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
___________________________________________________________________________
Signature__________________________________
Date____________________________
NOTE: This reference may be given to the student for inclusion in his/her application OR you may provide it
separately by delivering it to Room 372A or placing it in mailbox 134.
Oak Park & River Forest High School • Holmes Elementary School
POWER OF PARTNERSHIPS
Elementary School Internship
(SILC K-5)
Faculty/Staff Recommendation Form
Student’s Name_______________________ Faculty/Staff Member’s Name_________________________
The Power of Partnership/Senior Instructional Leader Corps Program (SILC K-5) is designed to offer interested
and qualified juniors and seniors the opportunity to work as a tutor/mentor to elementary school students at
Holmes Elementary. The above-named student is applying for the SILC K-5 program. Tutor/mentors are
expected to be exemplary role models and to demonstrate commitment to their own academic success. Your
input below will help us to select students who are both eager and able to fill the important role of tutor/mentor
for younger students.
 How long have you known this student and in what context? _______________________________
_______________________________________________________________________________________
 Please rate the student on each of the following characteristics:
Below
Average
Average
Good
(above
average)
Very Good
(well above
average)
Excellent
Work Ethic
Maturity
Motivation
Leadership
Integrity
Concern for others
Reliability
Self-confidence
Enthusiasm
Attendance
 Please share any other comments that will help us to evaluate this student’s readiness to work as a
tutor/mentor to younger students.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
___________________________________________________________________________
Signature__________________________________
Date____________________________
NOTE: This reference may be given to the student for inclusion in his/her application OR you may provide it
separately by delivering it to Room 372A or placing it in mailbox 134.