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About
About Us
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Volunteer
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Join Our Team
Impact
News
Events
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Changing Places, Changing Lives
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Service-Learning Program Application
Applications are accepted throughout the year on a rolling basis.
Name
*
First Name
Last Name
Student Email Address
*
Parent/Guardian Email Address
Home Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Home Phone
*
If you don't have one, put zeros in.
(###)
###
####
Cell Phone
*
If you don't have one, put zeros in.
(###)
###
####
How did you learn about this program?
*
How did you find out about this application? A teacher, a friend, guidance counselor, newspaper, Facebook, email list, other?
What school do you attend?
*
Choose one
Bassick
The Bridge Academy
Bridgeport Military Academy
Bridgeport Regional Aquaculture Science and Technology Center
Bullard-Havens
Central
Fair-Child Wheeler
Harding
Kolbe Cathedral
Other
If Other, please list school below.
What grade are you in?
*
Choose one
9th
10th
11th
12th
Which session(s) are you interested in applying to?
*
We run four (4) 8-week sessions per year - please choose the preferred session(s) you want to apply for.
Winter: January thru February (meets 3:45pm - 6:15pm)
Spring: April thru May (meets 3:45pm - 6:15pm)
Summer: July thru August (meets 9:00am - 1:00pm)
Fall: October thru November (meets 3:45pm - 6:15pm)
Which group(s) are you available to participate in?
*
Sessions run two days a week. Please choose the preferred session days that you would like to attend. If you have no preference and can attend either the Mon/Wed group or the Tues/Thu group, choose both.
Monday/Wednesday
Tuesday/Thursday
What are your favorite classes?
List any clubs you participate in and what days and times they meet.
Example: Spanish club on Tuesdays from 3 pm to 4 pm.
List any specialized training you have received (ex: car repair, woodworking)
Do you have any work, community service, or volunteer experience?
Choose one
Yes
No
How familiar are you with Groundwork Bridgeport?
*
Never heard of Groundwork Bridgeport.
Somewhat familiar with Groundwork Bridgeport.
Familiar with Groundwork Bridgeport.
Why would you like to participate in this program with Groundwork Bridgeport?
*
What skills do you hope to gain from Groundwork Bridgeport?
*
What immediately comes to mind when you think of the physical environment where you live?
*
How concerned are you about the physical environment where you live?
*
Not concerned
Somewhat concerned
Concerned
Very concerned
Provide an example of a project related to improving the physical environment that you would like to work on?
*
Plant a community garden
Clean up a park or river area
Grow native plants
Plant a tree
Educate neighbors about environmental issues
Establish a hiking trail
Other
What change would you like to see happen in the area where you live?
*
Do you have experience working within a team? (school club, sports team, church group) If yes, what were the benefits of working as a team? If no, how would you contribute to Groundwork Bridgeport's team?
*
What do you aspire to do after high-school?
*
How will this opportunity with Groundwork Bridgeport help you achieve your aspirations?
*
Would you participate in this program regardless of being provided a stipend at the end of the program?
*
Yes
No
Maybe
Please select the Sports/Physical activities below that you would be interested in participating in.
*
Basketball
Baseball/Softball
Swimming/Diving
Golf
Lacrosse
Tennis
Football
Soccer
Ice Hockey
Field Hockey
Cheerleading
Gymnastics
Sailing
Dance
Rugby
Skateboarding
Roller Skating
None of the above
Please select the Art/Music activities below that you would be interested in participating in.
*
Painting
Drawing
Photography
Pottery
Crafts
Piano
Violin
Guitar
Band
Singing/Chorus
None of the above
Please select the Miscellaneous activities below that you would be interested in participating in.
*
Cooking
Sewing
Chess
Travel
Fashion
Debate
Biology
Physics
Chemistry
General Science
Engineering/Computer Science/Technology
Math
Flower Gardening/Landscaping/Beautification/Farming/Food gardening
Environment/Nature
Making Bridgeport Better
Community Service/Helping Others
Politics/Civics
Journalism
Mentoring Program
Tutoring or Test Prep (PSAT, SAT, ACT)
Other
None of the above
Thank you!
