Bridging the Gap Program Application

Directions
Please complete the following questions to the best of your ability. Your application is a direct
reflection of you- please write legibly and neatly. In addition to your application, a statement of
support from a teacher, guidance counselor, or other school staff member must be completed
and included with your application at the time of submission.

PART I INDIVIDUAL INFORMATION

Name: _____________________________________________________________
Address: ____________________________________

Apartment # _________

Borough: ____________________________________

Zip Code: ___________

Date of Birth: _____/_____/_____

Cell Phone: (

Email: ______________________________

) __________________

Home Phone: ( ) ________________

Parent/Guardian: _________________________ Relationship: ______________

Parent/Guardian Cell Phone: ( ) _____________________
The following information is for demographic purposes only and will not affect your acceptance into the program.

Ethnicity:

Asian
African American
Caucasian
Latin/Hispanic
Native
American
Other:________

Gender:

Is English your first

language?

Male
Female

Yes
No

How did you hear

about this
program?

GPA: __________

Teacher
School
administrator
School counselor
Fellow student
Other:_______

Evaluators Use Only

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This program involves direct contact with the animals from the Departments handling
collection. Please list and explain any medical issues (such as allergies to fur, feathers, hay, or
pine shavings) that might affect your participation in this program. Do you currently have any
medical issues that could possibly preclude you from participation?
Please circle one: YES

NO

If you answered YES, please explain:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

PART II- SCHOOL INFORMATION

School Name: _______________________________________________________
School Address: _____________________________________________________
Borough: _____________________ School Phone: ( )_____________________
Principal: __________________________________________________________

Please circle current grade in school:

10

Evaluators Use Only

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PART III- APPLICATION

1. In the space provided below, write a brief essay explaining your reasons for applying to Bridging the
Gap and why you should be selected to participate.

________________________________
________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_________________________________________________________________________
3

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2. Will you be able to meet the attendance & participation requirements as outlined in the Bridging the
Gap Program Overview Sheet? Please circle one: YES

NO

3. What is/ are your strongest subject(s) in school? Why do you consider this/these subject(s) to be your
strongest?
________________________________________________________________________

________

________________________________________

4. What is/ are your weakest subject(s) in school? Why do you consider this/these subject(s) to be your
weakest?
________________________________________________________________________

________________

________________________________________________________________________________________________

5. At the current time, are there any science-related careers that interest you? Please name these careers.
_______________________________________________________________________________________
___________________________________________________________________________________

6. Are you interested in pursuing a career field that is not science related? If so, please tell us what field(s)
interests you and why.
_______________________________________________________________________________________
_______________________________________________________________________________________
________________________________________________________________________________
7. Do you prefer to work alone or with others? Explain your answer.
_______________________________________________________________________________________
___________________________________________________________________________________
8. Describe any involvement you have had with animals (pets, dog/cat sitting, etc).
__________________________________________________________________________________________________________
______________________________________________________________________________________________________

Evaluators Use Only

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9. How do you plan to travel to and from the program?

Bus
Walking
Subway
Car

10. Have you obtained information on any colleges and/or universities that you might be interested
in attending? Please Circle one: YES NO
If you answered YES, please tell us which colleges and/or universities?
_______________________________________________________________________________________
___________________________________________________________________________________

11. Have you had a conversation with your guidance counselor regarding your interest in the above
mentioned schools and/or taking the SAT or ACT for admission? Please Circle one: YES NO
If you answered YES, please answer the following question (11A):
11 A. What was the result of your conversation with your guidance counselor? Have you
received additional information on the colleges/universities in which you expressed interest?
Were you given guidelines as to when you should apply for and take the SAT or ACT? Explain.
_______________________________________________________________________________________
___________________________________________________________________________________

12. Are you involved in any extracurricular activities? If so, what activity and how many times a week
and/or what time of year do you participate?
_______________________________________________________________________________
________________________________________________________________________________
___________________________________________________________________________________

13. What additional information would you like to add in order to help us make a decision about your
acceptance into the program?

_______________________________________________________________________________________
___________________________________________________________________________________

PART IV- PARTICIPANT SIGNATURE AND PARENTAL CONSENT

Student:

I, _________________________________, have filled out this application honestly and to the best of my ability.

Signature of Student

Signature of Student

Date

Parent/Guardian:
** Parental consent is not needed if applicant is over the age of 18**
I, _______________________________________ (Parent Name) have read the Bridging the Gap
program overview distributed by Wildlife Conservation Society along with reviewing my
sons/daughters application. I understand and accept the conditions of this program and the extent of
my commitment and the commitment of my son or daughter.

Signature of Parent/Guardian

Date

Print Name

Evaluators Use Only Raw

Score:

Part V Statement of Support

To be completed by applicant and sponsor.

Instructions to Applicant
Refer this form to a sponsor (teacher or school administrator) familiar with your academic record and
personal character and have them complete it and return it to you. Make sure that your sponsor has
signed the form and included their contact information. Attach this form to your completed
application.
Please print neatly or type the following information:

Name of Applicant: ____________________________________________________________________

Name of Sponsor: _____________________________________________________________________

Instructions to Sponsor
In order to complete the application process for Bridging the Gap, each applicant must include a
statement of support from an appropriate sponsor. In the space provided below or on a separate sheet
(please use official stationery), please provide a statement concerning the aforementioned applicant.
Be sure to indicate how long you have known the applicant, and why you feel he/she would be a good
candidate for Bridging the Gap.
Check only one.
I strongly recommend the applicant without reservation.
I recommend the applicant.
I recommend the applicant with reservation.
PLEASE EXPLAIN YOUR CHOICE BELOW.
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________

___________________________________

_________________________________________

Signature of Sponsor

Phone: (

) _________________________

Name (Print)

Email: ____________________________________