STUDENT APPLICATION
Last Name:__________________ First Name:______________________
Address:_____________________________________________________
_____________________________________________________
City State Zip Code
Home Phone(___)_______________Cell Phone(___)_________________
Email___________________________________
School Attended:______________________Did you graduate: Y___N___
Subjects Studied:______________________________________________
Referred by:__________________________________________________
Please write a short essay between 100 & 300 words each for each of the following:
1. Have you ever engaged in volunteer or community outreach programs? Include what they were and the impact on your life.
2. List five personnel strengths and how you’ve applied them in you life.
3. List five personnel weaknesses and how you plan to change.
4. Where do you see yourself in five years?
5. How do you believe Polaris Foundation will help you?

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If selected you will be required to sign a statement of student responsibilities and conduct.
Be prepared for class and on time, complete all assignments, demonstrate humility,
Show respect for instructors and fellow classmates, work collaboratively with others,
Commit to the highest degree of professionalism and ethical standards.
If selected would you to able to committ to volunteer programs offered by Polaris Foundation?
Do you have a criminal record? Y____N____
If yes explain:_____________________________________________________________________________________________________________________________________________________________________________
Name:______________________________Date___________
Signature
Name;______________________________
I,____________________________( the student). Date:_________agree to be on
time and complete all classes and assignments. Demonstrate humility. Show respect
towards my instructors and fellow classmates. Work collaboratively with others, and
commit to the highest degree of professionalism, ethical standards and provide only the
best quality product or service. I further agree to actively participate in volunteer
programs sponsored by Polaris Foundation.
Signed:________________________________________
Signature
Signed:________________________________________
