Residential Program Residential Program ApplicationPlease 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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Primary Phone*Work PhoneOther PhoneEmail* 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 ExperiencePlease 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 ExperienceList 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 DutiesDate MM slash DD slash YYYY Position/Employer DutiesDate MM slash DD slash YYYY Position/Employer DutiesDate MM slash DD slash YYYY Position/Employer DutiesAre 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 RecommendationMax. file size: 300 MB.2nd Letter of RecommendationMax. 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.CAPTCHAUntitled Untitled Untitled