SENIOR CHRISTIAN SERVICE IMMERSION APPLICATION
SUMMER 2013
Due to Mrs. Barnes in Christian Service by break, Friday, November 2nd
APPLICATION CHECKLIST:
1. Step One: Student Applicant - Please Clearly Print Your Name Here: ____________________________
2. Step Two: Below select your first, second, and third choice for Immersion trips. Please keep in mind this
indicates you are available to go on any of the three trips you have chosen. You are also welcome to
check the box that says, “I am available to go on any immersion.” This is page one of your application.
3. Step Three: Type responses to the application questions (see next page). This is page two of your
application.
4. Step Four: By Tuesday, October 30, give two different teachers/counselors/staff at Jesuit the
recommendation forms attached to this application. This will give the recommender ample time to
complete your form. (Whoever completes your recommendation will return the form to Mrs. Barnes
personally.)
5. Step Five: Attach your signed Parent Statement to this application. This is page three of your
application.
6. Step Six: Staple an identifiable picture of yourself to the top of this application (please make sure not to
include other people in the picture).
7. Step Seven: Turn in your completed application and sign-up for an interview with Mrs. Barnes by break,
November 2. Be sure to put your interview time in your planner and please show-up on time! If you fail
to show up for your interview, your application process will be completed.
8. THANK YOU FOR YOUR APPLICATION! :)
Write the number 1 next to your first trip choice, then 2 for your second trip choice, and 3 for your third trip
choice.
_______Guatemala/El Salvador (July 28-Aug 7, 2013)
_______West Virginia (July 14-20 or 21-27, 2013)
_______Nicaragua/Costa Rica (May 26-June 5, 2013)
_______Detroit (June 2-8, 2013)
_______Kansas City (July 14-20, 2013)
_______Sacramento Urban Immersion (July 21-27)
_______Los Angeles (July 7-13, 2013)
_______Bay Area (June 2-8, 2013)
_______New Orleans (June 2-8, 2013)
_______I am open to going on any immersion trip.
Page 1 of Application
SENIOR CHRISTIAN SERVICE IMMERSION APPLICATION
SUMMER 2013
PLEASE TYPE YOUR ANSWERS ON A SEPARATE SHEET
1.
Why do you want to go on an Immersion trip? What do you imagine you will get out of this service
experience?
2.
What trip is your first choice and why? What trip is your second choice and why? What trip is your third
choice and why?
3.
Over the course of the trip you must be willing to completely immerse yourself in the experience of
simple living, community, prayer, and service. What do you anticipate might be the easiest part for you
and what do anticipate being the most difficult part for you? (To give you an idea of community living:
This would look like getting up early each morning, packing your own lunch each day, being flexible
and attentive to faculty instructions-even when you are tired!, participating in evening reflections-overall
being a positive and helpful contribution to the group).
4.
An important part of the Immersion is the evening Examen of the day. How do you envision yourself in
a communal Examen, sharing where you’ve been challenged throughout the day, where you found hope
and/or where you experienced God? Describe your level of comfort with daily reflection, prayer, and or
liturgy.
5.
Please describe in detail what you did for freshman, sophomore and junior service? Do you believe you
challenged yourself each year?
6.
This trip will require a lot of prep and follow-up work such as: doing regular readings, meeting at least
twice a month (during lunch) prior to going, and raising donations. Do you understand the commitment
you are making if accepted to this trip?
7.
Do you have any medical conditions or dietary restrictions we should be aware of?
8.
Anything else we should know or that you want us to know about you?
Page 2 of Application
SENIOR CHRISTIAN SERVICE IMMERSION APPLICATION
SUMMER 2012
TERMS OF FINANCIAL AID AND DONATION SOLICITATION
I.
Limited financial aid is available. Our Administrators will be determining how much aid can be
distributed.
II.
In addition to the trip cost, all students participating on an immersion are required to fundraise a
minimum donation of money, which is identified on the parent statement of this application. The
donations raised will be used to both offset any extra trip cost but primarily to donate to charities
your son works with during the immersion. Parents will be expected to make-up the difference if the
student falls short of this minimum. The primary way students have raised donation money in the
past is by writing letters to family, friends, and parishes explaining the trip’s purpose. All donation
money is due by Wednesday, May 1, 2013 to Mrs. Barnes.
II.
Donation checks should be made out to Jesuit High School and mailed directly to Kelly Barnes at
Jesuit High School. Mrs. Barnes will keep a running record of all student donations. Donations
are tax deductible and all donors will receive a thank you card and Tax ID number through the mail.
SENIOR CHRISTIAN SERVICE IMMERSION APPLICATION SUMMER 2012
PARENT STATEMENT
My signature indicates that the information on my son’s application is accurate and that he has my
permission to participate in this summer’s Christian Service Immersion program. I understand my son’s top three
Immersion trip choices and the cost of each of those trips. I understand that if my son is selected I will need to be
prepared to pay the full trip cost, unless I have requested and am then granted financial aid. Trips that are outside of
California have their prices determined by costs associated with airfare, ground transportation, housing, food,
reservation deposits to the non-profit agency running the Immersion, chaperone stipend, and educational activities.
Trips inside of California have their prices determined by costs associated with ground transportation, housing, food,
reservation deposit to the non-profit agency running the Immersion, chaperone stipend, and educational activities.
TRIP DATES & TRIP COST
Guatemala/El Salvador (July 28-Aug 7, 2013) - $2,700 + $250 Donations
Detroit (June 2-8, 2013) - $1,200 + $500 Donations
West Virginia (July 14-20 or 21-27, 2013) - $1,200 + $500 Donations
New Orleans (June 2-8, 2013)- $1,000 + $500
Sacramento Urban (July21-27, 2013)- $550 + $300 Donations
Bay Area (June 2-8, 2013) - $550 + $300 Donations
Kansas City (July 14-20, 2013) - $1,200 + $500 Donations
Los Angeles(July 7-13, 2013) - $650+$400Donations
Nicaragua (May 26- June 5, 2013) - $2,650 (Donation already included in price)
If my son is selected for a trip I will attend the designated parent evening in January and on that evening
bring a check made out to Jesuit High School for the amount disclosed in the acceptance letter which is sent over
Christmas break. (If you would rather setup an incremental payment plan, please inform Mrs. Barnes ahead of time.)
I am aware that trips outside of California need to purchase airplane tickets soon after the January parent meeting
and if plane tickets have been purchased the money is non-refundable. Please be aware that the non-profits we
contract with to host our Immersions have their own financial deadlines that Jesuit has already financed. Jesuit will
not be able to reimburse any deposits made on your behalf to the non-profits we contract with if a student decides to
withdraw from the trip. I understand that if my son needs to be sent home during an immersion trip, I am responsible
for the airfare and must chaperone him home.
I have read the information about donations and understand that if my son does not collect the required
donation minimum, I will be expected to make up the difference. I have also read the terms for receiving financial
assistance.
Please Circle One:
A.
Our family will not need assistance.
B.
Please consider our family for financial assistance.
In order for our son to participate we feel we can pay
towards the trip cost and also
(dollar amount)
understand that we are responsible for the fundraising commitment.
_______
Parent Signature
Date
_________________________________
Parent Name Printed Clearly
Page 3 of Application
SENIOR CHRISTIAN SERVICE IMMERSION
CONFIDENTIAL TEACHER RECOMMENDATION FORM
Please return directly to Kelly Barnes’ mailbox by Friday, November 2nd
Student Name: (Please Print)
_______________
Faculty Member: _(Please Print)_________________________________________
The above-named student is interested in participating in one of this summer’s Christian Service
Immersion trips. We would like your honest recommendation as to his suitability for going on an immersion
trip. We are looking for students who are mature, open to growing as a person of God, hard working, and
supportive of one another. Thank you for your input.
Please rate the student in the following areas (1 = low; 5 = high)
LOW
HIGH
1. Capable of putting others first
1
2
3
4
5
2. Contributes to a positive classroom environment
1
2
3
4
5
3. Is affirming of others (rather than critical)
1
2
3
4
5
4. Takes initiative (is a self-starter)
1
2
3
4
5
5. Follows directions
1
2
3
4
5
6. Sees work through to the end
1
2
3
4
5
7. Can honestly share his feelings
1
2
3
4
5
8. Can manage the challenge of
“culture shock” - flexible
1
2
3
4
5
9. Is able to reflect and articulate his experience
1
2
4
5
3
Additional Comments (PLEASE!)
Teacher Signature ________________________________________ Date _________________
Teacher’s Name Printed Clearly ______________________________
SENIOR CHRISTIAN SERVICE IMMERSION
CONFIDENTIAL TEACHER RECOMMENDATION FORM
Please return directly to Kelly Barnes’ mailbox by Friday, November 2nd
Student Name: (Please Print)
_______________
Faculty Member: _(Please Print)_________________________________________
The above-named student is interested in participating in one of this summer’s Christian Service
Immersion trips. We would like your honest recommendation as to his suitability for going on an immersion
trip. We are looking for students who are mature, open to growing as a person of God, hard working, and
supportive of one another. Thank you for your input.
Please rate the student in the following areas (1 = low; 5 = high)
LOW
HIGH
1. Capable of putting others first
1
2
3
4
5
2. Contributes to a positive classroom environment
1
2
3
4
5
3. Is affirming of others (rather than critical)
1
2
3
4
5
4. Takes initiative (is a self-starter)
1
2
3
4
5
5. Follows directions
1
2
3
4
5
6. Sees work through to the end
1
2
3
4
5
7. Can honestly share his feelings
1
2
3
4
5
8. Can manage the challenge of
“culture shock” - flexible
1
2
3
4
5
9. Is able to reflect and articulate his experience
1
2
4
5
3
Additional Comments (PLEASE!)
Teacher Signature ________________________________________ Date _________________
Teacher’s Name Printed Clearly ______________________________