2022 SCC Service-Learning Crew Participant Application
Thank you for your interest in the 2022 Montezuma County Service Learning Crew program!  Before submitting this form, please make sure you have read through the program information found at:
                                                    https://sccorps.org/four-corners-region-youth-crews-1
 
After reviewing information on our website, if you have any questions about the program or the application and enrollment process, please contact Teresa DiTore at tditore@conservationlegacy.org.  
 
Please be sure to complete this form completely and click the "submit" button when you are finished.
 
Session Information:  
SLC runs Monday-Thursday, 8:00AM- 4:30PM.  Pick up and drop off will be at the Cortez Public Library.
 
Session 1: June 6th - June 16th (THIS SESSION IS CURRENTLY FULL. WE ARE ACCEPTING APPLICATIONS FOR A WAITLIST)
Session 2: June 20th – June 30th
 
Applications will be accepted on a rolling basis and you will be notified if you have been accepted within a week of applying.

Please note that 2022 is our pilot year and we have a limited number of spots available. Our hope is to be able to expand this program in 2023 and offer more spots. All applicants who do not get accepted this year will be the first to know when the 2023 application opens next year.
 
Applicant Name *
(First + Last)
Email *
Age *
Birthday *
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Gender
Address *
Street address or PO Box, City, State and Zip code
Parent or Guardian Name (First and Last) *
Parent or Guardian Contact Information *
Phone Number and Email Address
School you attend *
T-Shirt Size (in adult size) *
Participants in this program are not covered by workers compensation and this is a volunteer program. Being covered by insurance is a requirement of the program. Do you have health insurance? *
All Conservation Legacy and SCC Participants and volunteers must be vaccinated against COVID-19 by the start of the program. Are you vaccinated against COVID-19? (Religious or medical exemptions are considered on a case-by-case basis and must be submitted separately.) *
Which Session are you interested in? (Each session is 2 weeks and runs Monday-Thursday from 8:00AM - 4:30 PM.) *
Required
Can you commit to both weeks in your chosen session? *
Drop off will be at 8AM at the Cortez Library and Pick-up will be at 4:30. Do you have reliable transportation to and from the Library each day? *
Why do you want to be a part of the Southwest Conservation Corp’s Service-Learning Crew? *
Parent or Legal Guardian Signature. By entering your name below, you are signing the application for participation in the SLC program.   *
Thank you for Submitting your application. Selected students will be notified in Mid-April! Please reach out if you have any questions! teresa@conservationlegacy.org
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