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									                       The Heston Summer Experience

                     APPLICATION FOR GETTYSBURG, PA




Instructions


    Please complete and submit this application by Friday, March 6.


    This application consists of:
      1. Application
      2. Resumé
      3. Letter of Recommendation

    Please send your completed application in Microsoft Word via email to
    Tammy Hoff at the Center for Public Service (thoff@gettysburg.edu).

    All the above items should be placed in ONE document. Include your name in
    the document title. Example: Application for Doe, Jane




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                 Center for Public Service ▪ 717-337-6490 ▪ www.gettysburg.edu/cps
                               Contact Tammy Hoff ▪ thoff@gettysburg.edu
                                     Located in Plank Gym by the Fountain
I. Personal Information

a. Contact Information


            Last Name                            First Name                  Male/Female            Date of Birth



           College ID #                       Social Security #              Email Address              Class Year



  Hall & Room or Off-Campus Addr                Campus Box                    Cell Phone #




    Primary Home Contact Name                Primary Street Addr              Primary City              State/Zip




         Primary Phone #




b. Gettysburg College Standing
Please highlight Yes or No to the following questions.

Are you in good academic standing with Gettysburg College?                                   Yes   No

Are you in good judicial standing with Gettysburg College                                    Yes   No

Are you in good standing with the Honor Commission?                                          Yes   No


If you highlighted “No” for any of the above, please explain.




c. Interview Availability

Interviews will be scheduled for Monday-Wednesday, March 16-18. Please let us know the blocks of time you
are free on these days.
        Monday, March 16: ________________
        Tuesday, March 17: ________________
        Wednesday, March 18: ________________




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                           Center for Public Service ▪ 717-337-6490 ▪ www.gettysburg.edu/cps
                                         Contact Tammy Hoff ▪ thoff@gettysburg.edu
                                               Located in Plank Gym by the Fountain
II. Statement of Purpose
Please address the following statements in a 1-2 page statement of purpose with regard to your participation in
this experience.

   HESTON EXPERIENCE
    Demonstrate interest and experience in community development and social justice issues.
    Demonstrate experience living and working in cross-cultural environments.
    Provide example of independent program development and implementation. Address your
      creativity and independence.
    Address a time when you had to adapt to an unfamiliar situation or live or work with few resources.




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                         Center for Public Service ▪ 717-337-6490 ▪ www.gettysburg.edu/cps
                                       Contact Tammy Hoff ▪ thoff@gettysburg.edu
                                             Located in Plank Gym by the Fountain
III. Skills and Qualifications
The following information will be presented to your host organization to finalize the details of your program.


            Last Name                              First Name                  Male/Female               Date of Birth




Education
Undergraduate Education


                University                                      Degree                       Year of Graduation


                  Major                                         Minor                              GPA




Relevant Experience
Please list relevant experience. This may include international and/or cross-cultural experience, academic
courses, professional engagements, trainings, or volunteer work. Please list as many experiences as are relevant,
typically 3-4 are appropriate.

Dates and Duration:
Class/Company/Organization:
Location:
Role:
Description of responsibilities and the skills you applied and/or developed through this experience:




Dates and Duration:
Class/Company/Organization:
Location:
Role:
Description of responsibilities and the skills you applied and/or developed through this experience:




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                             Center for Public Service ▪ 717-337-6490 ▪ www.gettysburg.edu/cps
                                           Contact Tammy Hoff ▪ thoff@gettysburg.edu
                                                 Located in Plank Gym by the Fountain
Dates and Duration:
Class/Company/Organization:
Location:
Role:

Description of responsibilities and the skills you applied and/or developed through this experience:




Dates and Duration:
Class/Company/Organization:
Location:
Role:

Description of responsibilities and the skills you applied and/or developed through this experience:




Language Skills
Please describe your language skills. Please be as objective as possible, and please do not over-estimate your
skill level. If you are having difficulty determining your language level, think about what level you would be at if
you were caught off guard and asked to speak Spanish with zero preparation. .


Indicate language and level of competency on a scale of 1-5
       Key:
       1 = No ability
       3 = Conversational/ Proficient (Able to understand and convey general meaning)
       5 = Fluent

                         Comprehension                              Ability
     Language                Reading                  Oral                 Written                 Spoken




Notes:



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                          Center for Public Service ▪ 717-337-6490 ▪ www.gettysburg.edu/cps
                                        Contact Tammy Hoff ▪ thoff@gettysburg.edu
                                              Located in Plank Gym by the Fountain
Skills
Please list specific skill sets that you have developed and could comfortably apply during your Heston
assignment if needed. It is okay if these skill sets do not seem directly related to the issue with which you would
like to work. For example, these skill sets might be related to research, writing, sports, computers, internet,
children, first aid, etc.

1.
2.
3.
4.
5.
6.




Interests
List any interests, hobbies.




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                           Center for Public Service ▪ 717-337-6490 ▪ www.gettysburg.edu/cps
                                         Contact Tammy Hoff ▪ thoff@gettysburg.edu
                                               Located in Plank Gym by the Fountain
IV. Heston Placement Interests
The preferences you indicate below will be used to identify the most appropriate host organization and project
work for you. While we encourage flexibility and a willingness to support your host organization’s needs and
priorities, at this stage it is to your benefit to be as clear as possible about your interests and priorities.



Issue Area                              Focus
Mark all that apply and rank in order   Please identify the sub-issue(s) within this field on which you would
of preference                           like to focus.
__ Elderly
__ Youth Enrichment
__ Poverty Alleviation
__ Migrant Families
__ Food Sustainability




Activities                              Details
Please indicate and rank the types of    Please provide specific details about what you would like to do.
activities in which you would like to be
 involved.
___      Research
___      Educational Workshops
___      Capacity-Building Workshops
___      Direct Service
___      Grant Writing
___      Publicity
___      Business Development
___      Infrastructure Development
___      Organizational Development
___      Other




Your Skills
Skills and knowledge you would like to apply:

1)
2)
3)


Skills and knowledge you would like to develop:

1)
2)
3)




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                         Center for Public Service ▪ 717-337-6490 ▪ www.gettysburg.edu/cps
                                       Contact Tammy Hoff ▪ thoff@gettysburg.edu
                                             Located in Plank Gym by the Fountain
  V. Health and Emergency Information
  The following information will be kept confidential and will only be used by CPS staff in making placement
  decisions and seeking appropriate care for you in the case of a medical emergency.

  1. Current Medical Issues and Medications
  a. Operations or serious injuries (including dates)




  b. Chronic or recurring illness or medical condition




  c. Dietary Restrictions




  d. Current Medications




  e. Other Diseases




  f. Additional Notes or Comments




  2. Health History
  Check all that apply and give approximate dates.

                       Date                                Date                             Detail             Date


Heart Defect/Disease                 Measles                             Drug Allergies
Convulsions                          German Measles                      Other
Diabetes                             Mumps                               Other

Bleeding/Clotting
Disorders                            Hay Fever                           Other
Hypertension                         Asthma                              Other
Mononucleosis                        Poison Ivy, etc.                    Other
Chicken Pox                          Insect Sting                        Other




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                              Center for Public Service ▪ 717-337-6490 ▪ www.gettysburg.edu/cps
                                            Contact Tammy Hoff ▪ thoff@gettysburg.edu
                                                  Located in Plank Gym by the Fountain
3. Emergency Contacts
Please provide the names and contact information for two individuals you authorize FSD to contact on your behalf
in the case of emergency.


Primary Emergency Contact


               Name                                Relation                            State of Residence


           Primary Phone                        Secondary Phone                                Email




Secondary Emergency Contact


               Name                                Relation                            State of Residence


           Primary Phone                        Secondary Phone                                Email




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                           Center for Public Service ▪ 717-337-6490 ▪ www.gettysburg.edu/cps
                                         Contact Tammy Hoff ▪ thoff@gettysburg.edu
                                               Located in Plank Gym by the Fountain
VI. Resumé
Please provide a copy of your résumé below.




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                        Center for Public Service ▪ 717-337-6490 ▪ www.gettysburg.edu/cps
                                      Contact Tammy Hoff ▪ thoff@gettysburg.edu
                                            Located in Plank Gym by the Fountain
VII. Reference Letter
Please provide one letter of character reference from a personal acquaintance that explains your suitability
for immersion and project work. We encourage you to request such a letter from someone who knows you
well in a variety of settings – this could be a colleague or peer, and in some cases a professor or employer.
Please do not request a letter of reference from a member of your family.




Note to Referee:
The Heston Summer Program: Communities in Action/Comunidades en Acción aims to further Gettysburg
College’s vision for active engagement in local and global contexts by providing a summer experience to
fourteen students. Through domestic and international immersion, students will have an extraordinary
opportunity to engage in the work of community action. The applicant that has requested a reference from
you has applied to the Adams County Program, which will be implemented by the Center for Public Service
at Gettysburg College.

Students will spend their time working with a community-based social service organization, experientially
learning and applying sustainable development solutions. Project work is collaboratively designed and
implemented by the participant, the Center for Public Service staff, and the host organization. In the end,
participants acquire development skills and training.

In selecting individuals to participate in our program, we rely upon the statements of referees. Based on the
length of time and the capacity in which you have known the applicant, we are particularly interested in your
frank appraisal of the applicant’s personal suitability for project work with a local service agency.

Please forward the attached information to Tammy Hoff, Office Manager - Center for Public Service, by mail
or by email, or provide to the applicant in a sealed envelope.


       Tammy Hoff
       Center for Public Service, Campus Box 2456
       Gettysburg College
       300 N. Washington Street
       Gettysburg, PA 17325
       717-337-6490
       thoff@gettysburg.edu


Please submit this reference no later than Friday, March 6, 2009.




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                         Center for Public Service ▪ 717-337-6490 ▪ www.gettysburg.edu/cps
                                       Contact Tammy Hoff ▪ thoff@gettysburg.edu
                                             Located in Plank Gym by the Fountain
Reference For: (Name of Applicant) _________________________________________________________

1. In what capacity have you known the applicant? (e.g. instructor, employer, peer, etc.)




2. For how many years/months?




3. Consideration of the applicant’s personal characteristics:

            Category                      High           Medium             Low               Unable to Assess
 Maturity
 Global Perspective
 Cultural Sensitivity
 Adaptability
 Diligence/Perseverance
 Judgment/Critical Sense
 Communication Skills
 Independent Initiative
 Teamwork and Collaboration
 Well-rounded

4. In your opinion, is the applicant well suited to work with a local service agency?

                 Very Well___          Well___           Adequately___        Inadequately___

5. Please provide your overall assessment of the applicant’s suitability for community work. Do not hesitate
   to use an additional sheet of paper to complete your comments or attach a letter.




Signature_________________________________________________              Date:_______________________________

Name of Referee:__________________________________________              Title:_______________________________

Tel.:_________________________________           Email:___________________________________________________



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                          Center for Public Service ▪ 717-337-6490 ▪ www.gettysburg.edu/cps
                                        Contact Tammy Hoff ▪ thoff@gettysburg.edu
                                              Located in Plank Gym by the Fountain

								
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