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.