Outdoor Leadership & Environmental Stewardship Program Application

Tell us about yourself.

Please type in your responses below and click SUBMIT.

Student Information

Last Name: First Name:   DOB (MM/DD/YYYY): Street Address:   Gender: Age: City: State: Zip: Home Phone:

Parent/Guardian Information

First Contact: Second Contact: Daytime Phone 1: Daytime Phone 2: Cell Phone 1: Cell Phone 2: Email 1: Email 2:

All costs and fees associated with stewardship activities will be paid in full by the Paul Simon Foundation

Emergency Contact (if not one of the above)

Name: Phone: Relationship to Child:

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1.  What school do you currently attend?   2.  What school clubs or extracurricular activities are you a member of?   3.  Are you available from July 11 thru July 29?   YES   NO


4.  Tell us about your outdoor education or environmental stewardship
      experience briefly:   5.  At this point go back and re-read the course description. 
      In one page or less describe why you are an ideal candidate for this program: