Compassionate Leaders 2015 Application

APPLICATION FOR COMPASSIONATE LEADERS PROGRAM
Full Name (include middle name):*
Date of Birth:*
 / 
 / 
Passport # (if available)
Address:*
Phone:*
-
E-mail:*
Name of High School
**Important**

To ensure the timely processing of your application, please title each file with your first and last name, followed by "essay" for the first uploaded file, and "reference" for the second.
Example: JohnDoeEssay.doc, JohnDoeReference.doc

Please Attach to this Application:
1) A short essay that describes why you are interested in participating in this program and what you expect to learn through your service projects.
2) A list of past and present employers and community service projects you have been involved with.

Upload Files*
**Important**

To ensure the timely processing of your application, please title each file with your first and last name, followed by "Letter of Recommendation".
Example: JohnDoeLetterofRecommendation.doc

Please Attach to this Application:
One confidential letter of recommendation. The letter should not be composed by members of your immediate family.
It can be e-mailed directly to noah@flourishfoundation.org or mailed to:
Flourish Foundation
PO Box 2429
Ketchum, ID 83340

Upload Letter of Recommendation*
Personal Interview

After filling out and submitting the entire application (including all releases and consents), please schedule a half hour personal interview by contacting Noah Koski at noah@flourishfoundation.org.
Students will be informed about their acceptance into the Compassionate Leaders Program by October 1st.

Submit the completed application before September 25th by email to noah@flourishfoundation.org fax 788-9777 or mailing it to Flourish Foundation PO Box 2429 Ketchum, ID 83340.

If you have any questions regarding this application or process, please contact Noah Koski, CLP Program Coordinator.

Expectations for all Participants

1. Community Service: Individuals must have a genuine passion for becoming more engaged in serving our community and making the world a better place. This program is not just about taking an interesting trip or fulfilling resume requirements for college applications.

2. Service Documentation: Each student is held accountable for completing a specified number of hours of local community service or random acts of kindness before the international trips. Every month students are required to record their community service hours online through a Compassionate Leader Program portal.
• India, Morocco and Philippines students are required 100 hours
• Mexico and Mississippi students are required 60 hours

3. Contemplative Practices: To help individuals in becoming more effective in their service projects and leadership roles, secular contemplative practices are taught on a weekly basis. To gain the greatest benefit from these practices all participants are strongly encouraged to practice these methods individually on a weekly basis either through the support of guided instructions in our audio library or through developing their own personal practice.

4. Weekly Meetings: The Compassionate Leaders Program meets on a weekly basis on Tuesdays at 6pm from October to June. These meetings are essential for accomplishing the service and fundraising goals and all participants must:
• Be able to attend all of the meetings
• Inform the group leaders if there are any scheduling conflicts. If a participant has more than 2 unexcused absences from the weekly meetings they may be asked to leave the program.
• Share ideas and follow through on assigned tasks
• Communicate any problems with the group and/or group leaders
• Be courteous and respectful to all members of the group
• Maintain confidentiality and respect the privacy of others

5. Fundraising: All participants are required to fundraise for their international service projects in the following way:
• India, Philippines and Morocco Students are required to fundraise a minimum of $1,000 before January 10th and another $1,500 before March 15th.
• Mexico and Mississippi students are required to fundraise a minimum of $750 before January 10th and another $950 before March 15th.
• All students are required to participate in organizing, setting-up, and breaking down at community fundraising events.
• All students are required to acquire in-kind donations for the international service projects.
• All students are required to thank personal donors and participant in the end of year community presentation.

In the case of dismissal or resignation from the program Flourish reserves the right to keep all donations from individuals or business, except for donations made by the program participant and by parent/guardian. All personal refunds must be requested in writing no later than May 1st.

6. Participant Led Evaluations: During the months of January and May students are required to self-evaluate their progress in the program and reflect upon areas for improvement. In addition to each participant, one parent may attend each evaluation meeting with the Program Leaders.

7. International/Domestic Service Projects: At the beginning of the school year, Flourish will provide information regarding the destination and criterion for participating in service projects outside the Wood River Valley. By March 15th the CLP Program Coordinator and CLP Leaders will assign students to a service project destination. These assignments will be based on attendance at weekly meetings and workshops, local community service hours, and fundraising. If a student does not meet the aforementioned criterion they may be deemed ineligible for participating in the end of year service projects.

8. Service Project Cost: All international transportation, in-country transport, medical kit, accommodations, food, water, major medical and travel insurance, and chaperone support fees will be covered by fundraising. Individuals will incur the cost of all travel documentation (e.g. passport, visa) and any recommended vaccinations. In addition participants are responsible for the costs of souvenirs, toiletries, laundry, and extra food and beverages.

9. Program Retainer Fee: Three weeks after a participant’s admittance to the program a non-refundable $300 fee is required to hold the participant’s space in the program. This fee is not tax exempt. If this commitment is not made the participant will be dropped from the program. Upon request, Flourish may grant need-based scholarships for this fee. All retainer fees will be applied toward the cost of implementing the CLP program.

10. Photo & Media Release: Flourish Foundation may use photographs/video of participants in the program for educational and publicity purposes.

I have read and understood all of the expectations outlined above and I understand a failure to comply with these expectations may result in a dismissal from the Compassionate Leaders Program. *
I have read and understood all of the expectations outlined above and I understand that if my son/daughter fails to comply with these expectations it may result in a dismissal from the Compassionate Leaders Program.*
COMPASSIONATE LEADERS PROGRAM
CODE OF CONDUCT FOR All PARTICIPANTS

I agree to obey the law of the United States and of any country associated with the Compassionate Leaders Program.

I will respect the property of others. This includes refraining from stealing, damaging or misusing the property of others.

I am not involved, nor will I become involved in illegal drug use, including possession and distribution. I am not involved in underage drinking as stipulated by U.S. law. Regardless of age, all participants are prohibited from alcohol use on international service projects and at Flourish events when minors are present.

I will always treat others respectfully throughout the duration of the Compassionate Leaders Program. This includes restraining from verbal abuse, physical abuse, sexual misconduct, sexual harassment, and behaviors that jeopardize the safety of others.

I will abide by the rules and regulations set by the project leaders. I will stay with the group and participate fully unless excused by a project leader. I realize that I am a member of team and will participate to the best of my abilities to accomplish the goals of the program.

I understand that all members of the Compassionate Leaders Program are representatives of the Flourish Foundation. At all times I will do my best to uphold the mission and guiding principals of the Flourish Foundation.

I agree that a single violation of this Code of Conduct may be a just cause for expulsion from the Compassionate Leaders Program locally or internationally. In the case of an international project, I will return home early at my own cost.

I have read and understand the code of conduct and fully agree to act in accordance with all its requirements.

Participant Signature / Date*
Parent Signature (if under 18)*
Parent Contact Sheet
Mother's Name:
Phone # (home, work & cell):
E-mail address:
Mother's mailing address:
Father’s Name:
Phone # (home, work & cell):
E-mail address:
Father's mailing address:
Step-mother/Guardian’s Name:
Phone # (home, work & cell):
E-mail address:
Step-mother/Guardian’s mailing address:
Step-father/Guardian’s Name:
Phone # (home, work & cell):
E-mail address:
Step-father/Guardian’s mailing address:
APPLICATION FOR COMPASSIONATE LEADERS PROGRAM
CONSENT FOR PARTICIPATION IN RESEARCH ACTIVITIES

Title of Project:
Measuring possible changes in positive personality characteristics
with participation in the Compassionate Leaders Program
IRB Approval Number
Dear Parent:

I would like to invite you to approve the participation of your child in a study that will examine how participation in the Compassionate Leaders program, a year long course in mindful practice, contemplation and service to others may affect self-reported levels of a number of positive emotions such as empathy, forgiveness and compassion.

We will be collecting survey data at three time points from the high school students participating in the Compassionate Leaders Program developed by Ryan Redman and the Flourish Foundation and we will test for any changes in students’ self reported levels of positive personality measures such as happiness, empathy, compassion, forgiveness, mindfulness, optimism, hope as well as changes in self-reported stress, emotional regulation, and anxiety. It will take approximately 30 to 40 minutes to complete each administration of the survey and the students may withdraw from the study at any time without penalty.

Risks and Benefits

There are no direct benefits to participants in this study other than helping to further our understanding of the possible benefits of participation in the Compassionate Young Leaders program.

Participation in this study involves minimal risk and your child will not be subjected to any procedure that is hazardous to his or her health. One copy of this document will be kept by the researchers. You will also be given a copy of this consent form to keep for your personal use or records.

Voluntary Participation

Your child’s participation is entirely voluntary and he or she may choose not to participate in this study at any time. Your child will not be penalized in any way should you choose not to participate or withdraw.

Privacy and Confidentiality

We will do everything we can to protect your child’s privacy. As part of this effort, his or her identity will not be revealed in any publication that may result from this study. In rare instances, a researcher's study must undergo an audit or program evaluation. This may result in the disclosure of data as well as any other information collected by the researcher. If this were to occur, such information would only be used to determine whether the researcher conducted this study properly and adequately protected your rights as a human participant. Importantly, any and all audits would maintain the confidentiality of any information reviewed by their office(s).

I/we have read this consent form. I/we also will be given a signed copy of this form for my/our records. I/we agree to participate in the research study described above, titled Measuring possible changes in positive personality characteristics with participation in the Compassionate Leaders Program. Parents, Guardian, or Legally Authorized Representative’s consent on participant’s behalf.*
Relationship to Research Participant*
Student’s Name: *
Student’s Date of Birth:*
Student Signature / Date*