| Name: |
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| Home/Mailing Address: |
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| Day Phone: |
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| Evening Phone: |
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| Primary Email Address: |
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| Secondary Email Address: |
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Please be sure to allow Earthwatch domain emails to be received. |
| Date of Birth (mm/dd/yyyy): |
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Gender:
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Male
Female
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School/Organization Type (check all that apply) :
Urban
Public School
Private School
Non-Traditional
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| School/Organization Name: |
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| School District: |
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| Mailing Address of School/Organization: |
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| School/Organization Phone: |
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| Number of Students You Teach Yearly: |
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| Grade Level(s) Taught: |
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| Subjects Taught: |
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| Number of Years Teaching: |
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Have You Joined an Earthwatch Expedition Before?
No
Yes
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If yes, how many? |
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Which projects and years? |
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| FIELDING AVAILABILITY AND PREFERENCES |
List date ranges you will be able to participate on an expedition.
Expeditions for this program are 1-2 weeks long and field during the school year. You
will be assigned to an expedition within your available dates.
Please
email fellowshipawards@earthwatch.org if these dates change. |
| I am available to participate on an expedition between these dates: |
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I have a passport
Yes
No
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Preferred Climate Change Research Areas (check all that apply):
Aquatic
Terrestrial
Plants
Animals
ANY
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| PROJECT ASSIGNMENT CONSIDERATIONS |
Earthwatch research expeditions take place in a wide variety of areas from urban environments to remote undeveloped regions, and they range in difficulty from easy to physically demanding. In order for Earthwatch to place you on a project that best matches your fitness and comfort level, it is important for you to accurately assess your abilities.
Please state any details of your personal and health history which may affect your participation in certain tasks or on some types of research projects. (If you are selected, for your safety, you will also need to complete an Earthwatch medical report which must be signed by your doctor.) Your answers to the questions below will not affect your application status. Earthwatch is committed to protecting the privacy of your personally identifiable information. The information provided here will solely be used for your appropriate placement and will only be shared with relevent Earthwatch staff.
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| Physical Fitness |
| What type of physical activity are you involved in on a weekly basis? Be specific with type and duration of physical activity. |
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How would you rate your level of fitness?
Light (walk 1 hour with ease)
Moderate (walk 3 hours with ease)
Strenuous (walk 3 hours over rough/different types of terrain carrying load)
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Special Skills - please check all that apply:
Non-Swimmer
Recreational Swimmer
Strong Swimmer
Current water lifesaving certificate
Snorkeling experience
SCUBA certified (designate certification)
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| Please list any additional special skills you might have (experience at high altitude, hiking, back country camping, boating, speak additional languages, CPR, Wilderness First Responder, Wilderness EMT, First Aid, etc.). |
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| Comfort and Experience |
| Please list any dietary needs/restrictions (e.g. food allergies, lactose intolerance, periods of fasting, vegan, vegetarian, etc.): |
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| Please list any physical or medical needs/restrictions (e.g. allergies, vision or hearing difficulty, mobility/agility concerns, recent surgery, etc.): |
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| Accommodation Comfort Level |
I am comfortable with accommodations that are: (Please check all that apply)
Primitive (camping, w/o running water and electricity)
Rustic (enclosed accommodation, running water and electricity)
Modern (hotel w/ full amenities)
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| Please list any climate concerns you might have (high/freezing temperatures, sun exposure, humidity, rainfall, etc). |
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| Additional Information |
| Is there anything else about yourself that we should know in order to place you on a project that will best suit you? Please be candid and attach additional comments regarding any personal concerns or limitations we should be aware of (i.e. phobias, etc). |
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| Disclaimer: Due to grant limitations, limited projects allocation, visa restrictions, and travel distances, we will appreciate your flexibility on the placement of a project and thank you in advance for working with us to meet your physical considerations with the Earthwatch expedition on which you will be fielding. |
| Principal Name: |
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| Email Address: |
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| Phone: |
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| STATEMENTS OF INTENT |
| Please answer each question below as thoroughly and completely as you can in 500 words or less. We recommend you compose these statements on your local machines in a word editor and copy and paste the content into the fields below. |
| A: How will you grow professionally and personally by participating in a conservation field research experience? |
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| B: How will you share your research experience with students? Educators? The general public? Please be specific. |
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| Please answer questions C and D if you would like to be considered for a "Live from the Field" expedition during the school year. |
| C: What kind of access will your students have to computers and the Internet while you are in the field? Have you ever used the Internet (web, email, online projects, digital imagery, cameras, etc.) in your teaching? Please specify the technology you feel most proficient with, and describe the context in which you have used it. |
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| D: Do you have a laptop and digital camera you can take on the project? Earthwatch will not be providing this technology. Please list the names and contact information of colleagues (e.g. technology coordinator and/or teachers at your school) who would be able to assist “back home” while you are in the field. (e.g. download and upload files from a FTP server to your web page or blog, help schedule/set up equipment for teleconferencing, and be a liaison with any substitute teachers while you are in the field) |
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How did you hear about this opportunity?
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| Past fellow |
| Team member |
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Earthwatch Field Rep - Name: |
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| School/Organization announcement |
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Publication - Name: |
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| Internet |
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Conference - Name: |
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Other |
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