Minnesota Peacemaker Project

2001 Youth Training Application

Please copy this form to another document or print it, fill it out, and return it using one of the options below.



Name_________________________________ Age______ Birthdate___/___/___
 

Current Address______________________________________ Good Until__________
 

City_________________________ State______ Zip______________
 

Phone_________________________ E-mail_____________________________
 

Gender: ___female ___male
 

Permanent address (if different from above)______________________________________________
 

________________________________________________________________________________
 

Phone______________________ Fax/E-mail_________________________
 

Name of Parent(s)/gaurdians___________________________________________________________

School (if applicable)______________________ Status in Fall 2001___________________
 

Are you interested in receiving academic credit for participation in the Minnesota Peacemaker Project?

____Yes, please contact me ____No, I am not interested

If yes, are you a student at an ACTC college?_____________________

Ethnic group (optional): African American____ Asian American____ Latino/a____

European American____ Native American____ Other_____________________
 

Religions affiliation, if any:_____________________________________________________________
 

How did you hear about the Minnesota Peacemaker Project?
 
 
 

Are you being sponsored for this program by an organization or group? If yes, please identify.
 


Please list a reference (can be academic, extracurricular, employment, etc.):
 

Name______________________________________ Phone______________________
 

Address_______________________________________________________________________
 
 

Emergency Contact: Name________________________ Phone_______________________
 

Parent/Guardian Consent (signature) if under 18______________________________________________
 
 


1) Describe yourself  20 words or less.
 
 
 

2) What do you hope to gain from participation in the Minnesota Peace Makers Project?
 
 
 
 
 

3) Have you had any experience organizing around peace and justice issues? If so, please describe briefly.
 
 
 

4) What streangths, skills, or resources will you bring to the group?
 
 
 
 
 

5) Are you able to commit to organizing a local project or action in the fall of 2001, including participation in group  planning meetings? Do you have concerns about fulfilling this commitment? (Inability to commit to completion of a project or to group meetings will not automatically disqualify applicants)
 
 
 
 
 
 

Please return to:

Fellowship of Reconciliation Minnesota Peacemaker Project
c/o Katrina Dolezal
225 5th Ave NE
St. Cloud, MN 56304
Phone: 320-229-7697
E-mail: katrina@cloudnet.com

If e-mailing this application as an attachment,
please save the file as a Word Perfect, MSWord, or Text document.
If you are not sure how to save the file as one of these options,
please include all of the information from the application in the body of your e-mail.