Global Sustainability Project Application
Application Deadline: Friday, October 18, 2019 at 3:00pm (No exceptions)
PART 1
Please complete all information in Part 1. Provide signatures and submit a hard copy of this application to Ms. Dang-Wright (Room # 823).
	 
Student Information		    
Student Name: 		Date of Birth:	
Address:		Apt:
City:		State:	Zip:
Email:		
Home Phone: 		Mobile Phone:
Gender:   

Parent/Guardian Information		    
Parent Name:			
Address:		Apt:
City:		State:	Zip:
Email:		Work Phone: 
Home Phone: 		Mobile Phone:
    
Parent/Guardian Information		    
Parent Name:				
Address:		Apt:
City:		State:	Zip:
Email:		Work Phone:
Home Phone: 		Mobile Phone:

About the Global Sustainability Project
The sponsor of the Global Sustainability Project is The Picerne Family Foundation, a 501(c)3 nonprofit private philanthropic foundation.  You may learn more about the Foundation and the Global Sustainability Project at www.picernefoundation.org.  The Earthwatch Institute, a nonprofit organization, is conducting the Amazon Riverboat research expedition.  You can read more about Earthwatch, the expedition, as well as review an in-depth expedition briefing at www.earthwatch.org or at the Picerne Foundation website above by clicking on Dana Hills High School. 

Agreement			
We have reviewed the Earthwatch website.  We request that the above student’s application, high school transcripts and educational achievements be considered for participation in the Global Sustainability Project (GSP). We give permission for the above student’s references and school personnel to be contacted and grade transcripts to be reviewed as part of the GSP application review process and for ongoing GSP eligibility if the above student is chosen as a GSP candidate. 

________________________________  
Student Signature and Date
School: Dana Hills High School		

_________________________________
Parent/Guardian Signature and Date	

__________________________________
Parent/Guardian Signature and Date