Great Lakes Regional Summit – Student Application

Great Lakes Regional Summit – Student Application

Application InstructionsThank you for your interest in attending the 2016 Great Lakes Native Youth in Food & Agriculture Regional Summit! The review committee looks forward to receiving your application and learning more about your interest in food and agriculture. The Student Application is for all students attending the Summit between the ages of fifteen to eighteen (including recently graduated high school seniors). If you are college-aged or have leadership experience in food and agriculture, you might consider completing the Student Leader application. You should submit your entire completed application to Kelsey Ducheneaux on the Indigenous Food & Agriculture Initiative staff using the contact information below:

To send application materials via emai l: kducheneaux@outlook.com, with “Great Lakes Application: YOUR NAME” as the subject line;

To send application materials via fax : 479-575-3320, addressed to: Indigenous Food & Agriculture Initiative, c/o Emerald Hames

To send via regular mail : IAC Technical Assistance c/o Kelsey Ducheneaux, PO Box 430, Eagle Butte, SD 57625

Review ProcessThe new student application deadline is March 15th, 2016. Materials must be emailed, faxed, or postmarked by 11:59pm CST that day to be considered by the admissions committee. The committee will review applications, and students will be notified of their application status, by the end of March. Late applicants will be placed on a waiting list to be reviewed on a rolling basis after the first round of new students have been admitted.

Great Lakes Regional Summit – Student Application

I. GENERAL INFORMATION

Name Tribal Affiliation(s)

Mailing Address City

State Zip Code E-mail address

Home Phone Cell Phone Texting Yes/ No

Date of Birth Gender T-Shirt Size

Preferred method of contact (home/cell phone, email, mail, etc):

Facebook Yes/No Twitter @ Instagram @

Will a travel stipend be needed in order for you to attend this event (circle one)?

Yes No; I have personal, local, or tribal support that can fund my attendance.

II. STUDENT INVOLVEMENT

Check all that apply

Maple Syrup Hunting Wild Rice

FFA Member 4-H Member Fishing

Horse Sheep Community Service

Crops/Grains Poultry Art

Sports Music Traditional Foods

______ Nutrition ______ Culinary Arts ______ Traditional Medicinal Plants

Student Government Community Garden Other (please specify)

Great Lakes Regional Summit – Student Application

III. STUDENT INTERESTS

What are you passionate about? List or summarize your interests.

IV. SUPPLEMENTARY INFORMATION

1. Résumé that includes evidence of academic achievement (G.P.A); 2. Statement of Interest:

1-2 page typed, double-spaced statement that: o Explains your interest in participating in the Great Lakes Regional

Summit;o Discusses your involvement in food and agriculture activities at home, in

your Tribe, your community, at your school, or elsewhere; ando Includes any membership and involvement in FFA, 4-H, or other food and

agriculture organization

Great Lakes Regional Summit – Student Application