COUNTRY OF ORIGIN:
Program APPLICATION
PROJECT RE-GENERATION
HUMAN RESOURCES
EMAIL ADDRESS
NAME: LAST
FOR
H.R.
DEPARTMENT
USE
DATE OF BIRTH
AGE
FIRST
Rejected
D
at
e
D
at
e
 Educ.
 Incomplete
 Late
 Availability
Accepted
677 Lafayette Ave
OTHER NAMES USED:
CURRENT NEIGHBORHOOD (E.G. BED-STUY):
Brooklyn, NY 11233
718.684.1014
MAILING ADDRESS: #
STREET
APARTMENT #
CITY:
STATE:
ZIP CODE:
HOME PHONE:
Sex
Male
 Other
Comments:
ALTERNATE PHONE:
PLEASE CHECK ALL THE CONDITIONS YOU’RE UNABLE TO PARTICIPATE
Female
How did you hear about PR-G?
After-school
_____________________________________________________________________
Part-Time
_____________________________________________________________________
_____________________________________________________________________
What careers are you interested in?
_____________________________________________________________________ FAMILY DOCTOR:
________
DR. PHONE:
Temporary
Weekends
ROP
FAMILY HEALTH PLAN:
EMERGENCY CONTACT INFORMATION:
POLICY NUMBER:
If “YES” complete the following:
Mother’s Full Name:
MEDICAL CONDITIONS:
Emergency Contact Person & #:
Relationship:
PHYSICAL LIMITATIONS:
Are you a high school graduate?
YES
NO
If yes, are you in college?
YES
NO
Can you obtain the following?
Most Recent
Report Card
High school Name:
Name
of School(s) Attended
Address:
City, State:
Current
High School
Transcript
Yes
Yes
No
No
If no why?
Bed Stuy’s Project Re-Generation, Inc.
Rites Of Passage (ROP)
ROP Program Overview
Program purpose:




To assist the educational system by providing basic knowledge and experience, which will prepare urban youth
for adulthood.
Activities:
42 hours - Financial literacy, health, life prep, relationship, & urban community Workshops
84 hours - Conduct all aspects of a community project & PR-G's Newsletter
36 hours - Volunteer/Work Opportunities
21 hours - Exercise/self defense
The ROP program will focus on PR-G’s three values:
I. Hard Work
Youth Always Committed To Outstanding Restoration (YACTOR): Our aim is to give young adults a sense of pride
in their community by beautifying it. Participants will be responsible for cleaning the sidewalks, gutters and yards
of the community.
Internships & Volunteer Experience: Participants will gain practical experience within one or two diverse
professional environments, aimed at developing various skills (see below).
Focus Points:
A)
B)
C)
D)
E)
F)
Discipline: punctuality, assignment completion, and quality of work.
Commitment: attendance, and assignment/task completion
Teamwork: work with peers, goal-setting, respect, fairness, patience, and tolerance
Responsibility: completion of time card, and time management
Goal Setting: identify, strategize, outline and measure
Skills: practical office experience including: MS Office, proper operations of phones, copiers, printers and fax
machines.
II. Community Care
Youth will be responsible for brainstorming, creating an action plan, implementing and evaluating one
community service project.
III. Personal Development – workshops topics include but are not limited to the following:
Health & Nutrition:
Nutrition:
– Reiki and Jinshinjitsu.
Healthy Relationships:
Sex Education & Disease – symptoms, signs, alternative protection, & options;
Sugar blues & fast foods, Cleansing, healing, fasting, juicing, raw foods; energy work
Police confrontation, Relationships in the black community, Love of self, friends &
Family, and Romantic or Dating Relationships
Life Preparation: Campus visits, research majors; the commitment, responsibility, and social life
Urban Community:
The Concept of Man/Woman hood, African Culture
Financial literacy:
Goal Setting, Basics on Banking, Checking & Savings accounts, Importance of Credit,
and Investments.
February begins Phase I of ROP 2004. Sessions will be held on Tuesdays from 4:30 to 7:00 p.m. and Saturdays
12:00-5:00 p.m. (subject to change). Participants are responsible for completing their required volunteer and
YACTOR hours.
Availability:
Can you commit to PR-G’s ROP program, knowing that it will require nearly all of your
Wednesdays from 4:30p.m. through 7:00p.m. and Saturdays from 11:30p.m. to 5:00p.m. for a
five month period.
Please Circle
Yes
___________________________________
No
if
no,
state
why?
state
why?
Can you commute from school or your home to Manhattan and Bed Stuy?
Please Circle
Yes
___________________________________
No
if
no,
Would you be willing to perform community service by cleaning up selected areas in Bed Stuy?
Please Circle
Yes
No
if
no,
state
why?
state
why?
____________________________________________
Are you willing to exercise at least once a week throughout the program?
Please Circle
Yes
____________________________________________
No
if
no,
Please complete the entire application, N/A where not applicable. If you need more space, attach
another sheet.
1. What do you think is one of the main problems that affect youth and/or adults in your
community? Please, describe the problem and its causes.
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
_______
2. How could this problem be solved? How could you be involved in addressing this issue?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
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3. Why are you interested in community service?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
_______
4. Have you ever participated in an after-school program and if so which one(s)?
______________________________________________________
_______ ______________________________________________
______________________________________________________
5. What are some of the skills, insights, and/or experiences you have gained by participating in
these programs?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
_______
Mail you applications to:
Bed Stuy’s Project Re-Generation, Inc.
The Magnolia Tree Earth Center
677 Lafayette Ave
Brooklyn, NY 11216