Harlem Clemente Course Application
Please fill out the application if you are interested in completing the course. This is simply an informational sheet that allows us to get to know you a bit and understand your interest the Clemente Program.

**The 2023 Fall Clemente Course will be held in person. A light supper and childcare will be provided.**
登录 Google 即可保存进度。了解详情
电子邮件地址 *
Dorothy Williams *
kooleaugustbreezes@gmail.com *
2 Wayne Way White Plains, New York 10607-1025 *
914-522-4235 *
Last Grade Completed

 2nd year college
 *
Are you currently enrolled in any educational programs? If so, which one?  NONE *
How did you hear about us? (Referred by friend or employee, Website, etc.)

Through Montefiore email
 *
Tell us a little bit about yourself.

I'm currently part-time at Montefiore.
I'm Happy, I'm Healthy, and I'm Human
I'm looking to improve my skills with living in the current world.


 *
Why are you applying to the Clemente Course?

I'm applying for the course to increase my humanity skills.
 *
What do you like to read? Name a few of the most recent books you've read.

I prefer non-fiction readings
 
The Holy Bible (daily)

She Speaks by Michele Clark Jenkins

Our Daily Bread (daily)

The Courage to First by Linda Fegins

The Warmth of other Suns  by Isabel Wilkerson
 *
What challenges you most about reading and writing?

The truth about making sure the information is accurate.
 *
What do you hope to learn or achieve in the Clemente Course? Write at least three statements that begin with the words, "In this course, I want to..."

In this course I will improve my listening skills

In this course I will improve my writing skills

In this course I will improve my people and attitude skills
 *
What will you need to do to accomplish the goals you've listed above?

Self affirmation and an instructor with wisdom to guide.
 *
How can the instructors help you accomplish these goals?

The instructors can help me accomplish these goals by first knowing how to administer them from experience.
 *
Do you really believe you will be able to attend all classes twice per week for eight months? Do you foresee any challenges? Do you have any questions or concerns as this class begins that you'd like the instructor to address?

Yes, twice a week is doable. 

The challenges will be the traffic and perhaps the upcoming inclement weather.

At this time there are no concerns, the questions is there a study course book, if yes, what is the cost, is there a written syllabus.

 *
Do you have wifi access?

Yes 
 *
Do you have access to a device to participate in on-line classes; to use on-line reading materials and videos?

Yes
 *
Have you ever used ZOOM?

Yes
 *
Would you like someone to assist you with the technology?

Yes
 *
Is there anything else you'd like to share with us?

I'm fortunate to be able to have this course offered at no cost.
 *
Please list contact information (phone numbers/email addresses) of three personal references.

Unfortunately I don't have the emails 

Dr. Verlin D. Williams    914-815-6926
Ms. Candacee Williams  914-419-3983
Rev. Daphne Swinton 914-564-9070
 *
The Clemente Course is an unusual opportunity that we are offering to a few select individuals who are dedicated to attending regularly on Tuesdays and Thursdays in the evening for the entire 8-month course. By signing below you agree to attend all class sessions and participate fully in the course.   *
提交
清除表单内容
切勿通过 Google 表单提交密码。
此内容不是由 Google 所创建，Google 不对其作任何担保。 举报滥用行为 - 服务条款 - 隐私权政策
Google 表单