2011-2012

Cesar E. Chavez Fellowship

Application

Giving youth, teens and families the opportunity to empower themselves and achieve success in school, at home, and in their community!

Applicant Information
First Name: Current Address:
City: State:

Last Name:

Zip Code: Work Phone: E-Mail Address:

Home Phone: Cell Phone: Permanent Address: City:

Best way to reach you (check one):

State:
Phone, Best time: Email:

Zip code:

Place of Birth (City and State):

Gender:

Female

Male

Academic Information
List all current and previous colleges and universities you have attended:
College/University Month/Year Attended Major /Degree Year received GPA

1. 2. 3.

Other professional certifications:

Language Skills
Spanish Speak Read Understand Write

(Check all that apply): Other Speak Read Understand Write Other Speak Read Understand Write

University/College Activities & Community Leadership

List activities in which you have participated in college (cultural, service, athletic, political, volunteer, employment) and leadership roles both on campus and in the community. Give dates and estimates of time (e.g. hours per week) involved in each activity. Distinguish between ongoing and one-time commitments.

Experience working with children

In an essay summarize an opportunity you have had to teach children or youth, such as summer camp, church, volunteer program, athletics. You must include a description of what you did, number of students, duration of the experience, something you learned about teaching from this experience, and how it influenced you.

Personal Statement
Please describe your educational and career goals and personal factors that have influenced your decision to pursue this fellowship.

References
Please list below 3 people that have known you for more than a year, to complete a reference form. They should know you well enough to judge your character, motivation, and evaluate your qualifications. Don't include any family members, and one reference must be a university/college faculty. Reference Form: We will be emailing your references a form to complete. We will email you to inform you when we will be sending your references the form. Name: Phone Number: Name: Phone Number: Name:

Relationship:
Email:

Relationship: Email: Relationship:

Email:

Phone Number:

Agreement and Signature

By submitting this application, I affirm that the facts set forth in it are true and complete, to the best of my knowledge. I understand that if I am accepted as a fellow, any false statements, omissions, or other misrepresentation made by me on this application may result in my immediate dismissal. I understand that the Cesar Chavez Foundation retains full and final authority for the acceptance of fellows and retains the right to decline or accept the service of any individual. In addition, any changes to the above information (i.e. personal information or criminal record) must be reported to the Cesar Chavez Foundation.

Initial :

Date:

Checklist
Please submit all documents with your application. We will not accept any incomplete applications.

Completed Application

Photo of yourself

Resume

Send Application
Please send your completed application electronically to cgloria@chavezfoundation.org

Application Deadline
Early Submission must be post marked by December Regular Submission must be post marked by

16, 2011;

Early submission will be notified no later than March 2012

April 9, 2012;

Regular submission will be notified no later than June 2012

Si Se Puede! Learning Center Locations

The National Office Staff will determine the location of your placement based on availability and where your skills will be best utilized. New Mexico Albuquerque, NM - Plaza David Chavez Albuquerque, NM - La Vida Nueva Albuquerque, NM - Sandia Vista California San Francisco, CA - Vista del Monte Gilroy, CA - Gilroy Apartments Hollister, CA - Villa Luna Fresno, CA - Casa Velasco Bakersfield, CA - Govea Gardens Shafter, CA - Casa Amelia Cadena Arizona Somerton, AZ - Hacienda Manuel Chavez Phoenix, AZ - Glenbrook Terrace El Mirage, AZ - Plaza Manuel Ortega Texas Pharr, TX - Jardines de la Fuente Mercedes, TX - Casa Saldana Edcouch, TX - Casa Messina Temple, TX - Village at Meadowbend San Antonio, TX - Aguila Oaks