The Collaborative Center for Community-Based Research and Service
Rutgers, The State University of New Jersey
640 Bartholomew Road Piscataway, NJ 08854-8003
Tel: (848) 932-8660 Fax: (732) 445-4231
civic@rci.rutgers.edu
The Collaborative Center for Community-Based Research and Service
Common Application Form
Application Date
Name
Phone Number
Class Year
RU NetID
Major(s)
Current Address:
Permanent Address
Semester/Year
Email
Fall
Spring
School/Campus
RU ID # :
Minor(s)
Race/ Ethnicity:
(optional)
Gender: (optional)
TRANSPORTATION
Year
Students must provide their own transportation to and from service site.
Please check only one:
Own a vehicle to transport yourself
Public Transportation
How did you hear about our programs?
Languages studied or spoken and proficiency
I understand that submitting data on my gender, race, ethnicity, disability status, and veteran status is voluntary. Leaving these fields
blank will not affect my participation in the program. I am granting my permission to release all information I provide to individuals
deemed appropriate by the program staff, to which I am submitting this information. I am giving permission to Rutgers to record my
image and/or voice and grant Rutgers all rights to the use of these recordings or photographs in any medium for educational, promotional
advertising, or other purposes that support the mission of the university. I understand that by checking this box and submitting this
application I have read and understand these terms and conditions and give my consent to the above statements.
I would like to apply to the following programs: (check all that apply)
Yearlong Programs
Advancing Community Development
Behavioral Assistant Program
Rutgers Bonner Leaders Program
Semester Programs
The Collaborative’s Mentoring Program
Community Research Assistant
The Conversation Tree Program (does not require transcripts and resume)
Please submit transcripts and resume
with application in order to be considered!
Common Application Form
The Collaborative Center for Community-Based Research and Service
Rutgers, The State University of New Jersey
640 Bartholomew Road Piscataway, NJ 08854-8003
Tel: (848) 932-8660 Fax: (732) 445-4231
civic@rci.rutgers.edu
References
Name
Dept.
Phone
Email
Fax
Name
Dept.
Phone
Email
Fax
Personal Statement
What motivates you to serve?
(Insert essay here)
Please submit transcripts and resume
with application in order to be considered!
Common Application Form
The Collaborative Center for Community-Based Research and Service
Rutgers, The State University of New Jersey
640 Bartholomew Road Piscataway, NJ 08854-8003
Tel: (848) 932-8660 Fax: (732) 445-4231
civic@rci.rutgers.edu
Instructions
Students may apply to one or more of The Collaborative Center programs by using the common application.
All of The Collaborative Center programs accept undergraduate students from all majors/academic
backgrounds. Students submitting applications must attach resume and transcripts*.
When submitting your application materials please submit all materials to each program(s) email address, if you
are applying to more than one. The subject line on the email should read: your last name, Application, Semester
Year. For example: Doe, Application Spring 2015. For general inquiries, email civic@rci.rutgers.edu
Program
Advancing Community Development
Behavioral Assistant Program
Rutgers Bonner Leaders Program
The Collaborative’s Mentoring Program
Community Research Assistant
The Conversation Tree Program*
Contact Email
rutgersacd@gmail.com
Rutgersbehavioralassistant@gmail.com
rutgersbonner@gmail.com
collaborativementoring@gmail.com
rutgerscollaborative.cra@gmail.com
Jessica.hunsdon@gse.rutgers.edu
Selection Process
 FIRST STAGE: Interested students should submit their application and required materials
 SECOND STAGE: Promising candidates will be contacted for an interview. Submission of application does
not guarantee interview.
 THIRD STAGE: Final decisions will be announced
Priority Acceptance: Classes are limited in space; however, we currently offer rolling admission.
*For those applying to The Conversation Tree, please submit only the application form transcripts and resume
are not necessary.
Please submit transcripts and resume
with application in order to be considered!
Common Application Form