Copy of T.M.A.D Interest Application 2018-2019 Question Title * 1. What is your FIRST name? OK Question Title * 2. What is LAST name? OK Question Title * 3. What is your AGE? OK Question Title * 4. What is your HOME address? OK Question Title * 5. What is your EMAIL ADDRESS? (this email will be used for communicating purposes during the duration of the program) OK Question Title * 6. What is your CELL PHONE number? (this number will be used for communications purposes during the duration of the program) OK Question Title * 7. Please prove the NAME, PHONE NUMBER and EMAIL ADDRESS of your PARENT and or GAURDIAN. OK Question Title * 8. Please provide the NAME and PHONE NUMBER of the person we should call in the case of an EMERGENCY. OK Question Title * 9. What is you relationship with this person? Mother/Father Guardian Aunt/Uncle Friend of the Family Other (Please specify) OK Question Title * 10. What GRADE are you in? 7th Grade 8th Grade 9th Grade 10th Grade 11 Grade 12th Grade OK Question Title * 11. What MIDDLE or HIGH SCHOOL do you attend? OK Question Title * 12. How did you hear about the T.M.A.D program? Internet (Arlington County Website) Posted Flyers, Newspaper Middle/High School Activity Fair Family, Friend Arlington County Parks and Recreation Staff School Staff Member or Counselor Other (please specify) OK Question Title * 13. Identify 2 leadership positions you have held. Include present and past volunteer, community or religious involvement with the name of organization(s), position(s) you have held, your responsibilities, duration and the name of your immediate supervisor (s). OK Question Title * 14. What is your definition of a leader? Why do you feel you would make a great leader in your community?*Please type your essay, and send to ajerry@arlingtonva.us Word Requirements (Middle School Students: min.150 max.500 words) (High School Students: min.200 max.500 words) I understand the short essay requirement and will submit my essay. I do not understand the short essay requirement and will not submit my essay. OK Question Title * 15. Please share why you should be chosen to participate in the T.M.A.D experience?*Please type your essay, and send to ajerry@arlingtonva.us Word Requirements (Middle School Students: min.150 max.500 words) (High School Students: min.200 max.500 words) I understand the short essay requirmeent and will submit my essay. I do not understand the short essay requirement and will not submit my essay. OK Question Title * 16. What do you hope to gain from your T.M.A.D experience?*Please type your essay, and send to ajerry@arlingtonva.us Word Requirements (Middle School Students: min.100 max.500 words) (High School Students: min.100 max.500 words) I understand the short essay requirement and will submit my essay. l do not understand the short essay requirement and will not submit my essay. OK Question Title * 17. FINAL REQURIEMENT: Please SUBMIT one (1) letter of recommendation from an academic advisor, mentor, or counselor. References cannot be from family members. Please include name, job title and or position, address; city, state and zip code, phone number and email if available. Recommendation DUE: *date will be given at first TMAD meeting.**Please return all forms to Desi Jerry at ajerry@arlingtonva.us**For more information call: (703) 228-7781 I understand the above statement, and will have my recommendation by the stated date above. I do not understand the above statement, and will not have my recommendation by the stated date above. Comments: OK DONE