Residential Program - New Opportunity School for Women

Residential Program Application
Please read and answer the questions below. If a question does not apply to you, leave the question blank.
Today's Date*
MM slash DD slash YYYY
Name*
First Last
Name that you wished to be called
Date of birth*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Phone*
Work Phone
Other Phone
Email*
Marital Status*
Number of children and their ages
Name, relationship, and age of all persons currently living in your home:
Your ethnic origin
- White
- African American
- Asian or Pacific Islander
- Hispanic
- American Indian or Native Alaskan
- Other
Information requested is voluntary. It will not be used in making a selection decision, but is collected for institutional research and reporting purposes.
Educational Experience
Please list and give the dates of any high schools, colleges, business, or vocational schools that you have attended and degrees or certificates awarded to you, including GED.
Date
MM slash DD slash YYYY
School
Highest Level Achieved
Date
MM slash DD slash YYYY
School
Highest Level Achieved
Date
MM slash DD slash YYYY
School
Highest Level Achieved
Date
MM slash DD slash YYYY
School
Highest Level Achieved
Job Experience
List any jobs that you have held since high school and the approximate date you held the job. Briefly describe your duties in each position. Please start with your most recent work experience.
Date
MM slash DD slash YYYY
Position/Employer
Duties
Date
MM slash DD slash YYYY
Position/Employer
Duties
Date
MM slash DD slash YYYY
Position/Employer
Duties
Date
MM slash DD slash YYYY
Position/Employer
Duties
Are you currently employed?*
- Yes
- No
If yes, how many hours a week do you work?
If you have recently stopped working, please state the reason.
Please list any volunteer work you may have done in your community, church, or school.
Have you previously had career courses or career counseling?*
- Yes
- No
If yes, please give date and describe.
Have you applied to a college or vocational school within the last year?*
- Yes
- No
If yes, list the school.
Have you been accepted?
- Yes
- No
When do you plan to begin?
Please understand that the two-week residential program generally requires physical activities including but not limited to walking (i.e. walking to and from classes, field trips, etc.), climbing stairs, and sitting for long periods of time (i.e. class, riding in a vehicle, etc.). Please also know that the New Opportunity School takes very seriously its role as host to a number of participants each session, and will require each participant to conduct herself in a safe and productive manner.
Because the New Opportunity School seeks to serve those of limited financial resources, income will be a strong consideration in choosing participants for the program. Please check the category that best represents your FAMILY income.
- $0-10,000 per year
- $10,000-15,000 per year
- $15,000-20,000 per year
If over $20,000 per year, please list the amount per year.
*List sources of income. (For example: your work, your husband's work, alimony, welfare benefits, ect.)*
List any recent unusual financial difficulties. Please explain.
Have you ever been convicted of a felony or misdemeanor by any court including local, state, federal, or military?*
- Yes
- No
Is yes, please give date and explain.
I give my permission for a background check.
- Yes
- No
*How did you hear about the New Opportunity School for Women?*
There is a limited amount of money available for child care and travel expenses. Please list the total amount of money required for travel expenses to come to Berea for the two-week session, if any.
Please list the total amount of money required for child care expenses while in Berea for the two-week session, if any.
If selected, I agree to attend the two-week program of the New Opportunity School for Women and participate fully in all scheduled activities.
Signature of applicant*

By typing your name you agree that this represents your signature.
Date*
MM slash DD slash YYYY
Attach to this application two letters of recommendation from people who know you well (i.e. ministers, teachers, employers, social workers). Please ask that they describe their relationship to you, how long they have known you, and why they feel you would be a good candidate for this program. They should also include their contact information and phone number on their letter. Please do not use family members.
1st Letter of Recommendation
Max. file size: 300 MB.
2nd Letter of Recommendation
Max. file size: 300 MB.
Please write one or more pages about why you want to attend the New Opportunity School for Women and how you think it will help you. Feel free to discuss any unique circumstances that you think merit consideration. Without this personal statement and two letters of recommendation, your application will not be considered. You may paste it into the box below or attach it in a file.
Max. file size: 300 MB.
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Residential Program Application

Educational Experience

Job Experience

If selected, I agree to attend the two-week program of the New Opportunity School for Women and participate fully in all scheduled activities.

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