Application For Ecology Action's GROW BIOINTENSIVE 8-Month Internship Program—2017 Season Ecology Action's 8-Month Internship Program immerses participants in all aspects of biologically intensive food raising. Interns will learn practical skills and teaching techniques through their involvement in day-to-day farm work and an integrated classroom learning program curriculum. By the end of the program, interns will have gained hands-on experience and a comprehensive understanding of the designing, planning and management of a small-scale biologically intensive mini-farm and teaching the GROW BIOINTENSIVE (GB) Method. The 2017 internships begins April 1, 2017, & the application deadline is March 7, 2017. If you are interested in applying for this internship, you must first: Read the website information on program description, expenses, schedule, reading list, and site descriptions at: growbiointensive.org/Internship/8Month.html. Read the Internship Program and Information Booklet at: growbiointensive.org/PDF/InternBooklet.pdf. Read A Farmer's Mini-Handbook: GROW BIOINTENSIVE Sustainable Mini-Farming at: growbiointensive.org/PDF/FarmersHandbook.pdf. Read Ecology Action's Letter of Expectations for Internship at: growbiointensive.org/Internship/8MI-Expectations.pdf. Fill out and submit the following application. Applicants should note that this is an unpaid, fee-based internship program with limited scholarship opportunities. Program fees include room, board, tuition, books and incidental expenses and are non-refundable. Do not send payment until you have been notified of your acceptance to the program. Once you are accepted, you will receive further information on schedules, site placement, preparation and payments. '*' fields are required. Please Upload Your Application Documents Here: Required Reading Waiver: I have read Ecology Action's Letter of Expectations, and I agree to all terms therein. I have read the website information on program description, expenses, schedule, reading list, and site locations; the Internship Program and Information Booklet; and the GB Farmer's Mini-Handbook. I will make myself available for a Skype interview beginning July 1st through July 15th. Completed Medical Report * Limited to a 6 megabyte file upload. The blank form may be downloaded at: growbiointensive.org/PDF/InternMedicalReportForm-ForUpload.pdf Letter of Reference #1 * Limited to a 6 megabyte file upload. Letter of Reference #2 * Limited to a 6 megabyte file upload. Letter of Reference #3 * Limited to a 6 megabyte file upload. Passport Scan (if available) Limited to a 6 megabyte file upload. If selected, your passport will need to have a validity date at least six months beyond your internship program ending date. Contact Information Do you currently have a valid passport? * Yes No If "Yes" please upload a color passport scan above. Title - None -Mr.Mrs.Ms.MissProf.Dr.Other... Title Other... First Name/Given Name - as it appears on your passport (or legal documents if you do not yet have a passport) * Last Name/Surname/Family Name - as it appears on your passport (or legal documents if you do not yet have a passport) * Nationality / Citizenship * - Select -UNITED STATESAFGHANISTANALAND ISLANDSALBANIAALGERIAAMERICAN SAMOAANDORRAANGOLAANGUILLAANTARCTICAANTIGUA AND BARBUDAARGENTINAARMENIAARUBAAUSTRALIAAUSTRIAAZERBAIJANBAHAMASBAHRAINBANGLADESHBARBADOSBELARUSBELGIUMBELIZEBENINBERMUDABHUTANBOLIVIABOSNIA AND HERZEGOVINABOTSWANABOUVET ISLANDBRAZILBRITISH INDIAN OCEAN TERRITORYBRUNEI DARUSSALAMBULGARIABURKINA FASOBURUNDICAMBODIACAMEROONCANADACAPE VERDECAYMAN ISLANDSCENTRAL AFRICAN REPUBLICCHADCHILECHINACHRISTMAS ISLANDCOCOS (KEELING) ISLANDSCOLOMBIACOMOROSCONGOCONGO, THE DEMOCRATIC REPUBLIC OF THECOOK ISLANDSCOSTA RICACOTE D'IVOIRECROATIACUBACYPRUSCZECH REPUBLICDENMARKDJIBOUTIDOMINICADOMINICAN REPUBLICECUADOREGYPTEL SALVADOREQUATORIAL GUINEAERITREAESTONIAETHIOPIAFALKLAND ISLANDS (MALVINAS)FAROE ISLANDSFIJIFINLANDFRANCEFRENCH GUIANAFRENCH POLYNESIAFRENCH SOUTHERN TERRITORIESGABONGAMBIAGEORGIAGERMANYGHANAGIBRALTARGREECEGREENLANDGRENADAGUADELOUPEGUAMGUATEMALAGUERNSEYGUINEAGUINEA-BISSAUGUYANAHAITIHEARD ISLAND AND MCDONALD ISLANDSHONDURASHONG KONGHUNGARYICELANDINDIAINDONESIAIRAN, ISLAMIC REPUBLIC OFIRAQIRELANDISLE OF MANISRAELITALYJAMAICAJAPANJERSEYJORDANKAZAKHSTANKENYAKIRIBATIKOREA, DEMOCRATIC PEOPLE'S REPUBLIC OFKOREA, REPUBLIC OFKUWAITKYRGYZSTANLAO PEOPLE'S DEMOCRATIC REPUBLICLATVIALEBANONLESOTHOLIBERIALIBYAN ARAB JAMAHIRIYALIECHTENSTEINLITHUANIALUXEMBOURGMACAOMACEDONIA, THE FORMER YUGOSLAV REPUBLIC OFMADAGASCARMALAWIMALAYSIAMALDIVESMALIMALTAMARSHALL ISLANDSMARTINIQUEMAURITANIAMAURITIUSMAYOTTEMEXICOMICRONESIA, FEDERATED STATES OFMOLDOVA, REPUBLIC OFMONACOMONGOLIAMONTENEGROMONTSERRATMOROCCOMOZAMBIQUEMYANMARNAMIBIANAURUNEPALNETHERLANDSNETHERLANDS ANTILLESNEW CALEDONIANEW ZEALANDNICARAGUANIGERNIGERIANIUENORFOLK ISLANDNORTHERN MARIANA ISLANDSNORWAYOMANPAKISTANPALAUPALESTINIAN TERRITORY, OCCUPIEDPANAMAPAPUA NEW GUINEAPARAGUAYPERUPHILIPPINESPITCAIRNPOLANDPORTUGALPUERTO RICOQATARREUNIONROMANIARUSSIAN FEDERATIONRWANDASAINT BARTHELEMYSAINT HELENASAINT KITTS AND NEVISSAINT LUCIASAINT MARTINSAINT PIERRE AND MIQUELONSAINT VINCENT AND THE GRENADINESSAMOASAN MARINOSAO TOME AND PRINCIPESAUDI ARABIASENEGALSERBIASEYCHELLESSIERRA LEONESINGAPORESLOVAKIASLOVENIASOLOMON ISLANDSSOMALIASOUTH AFRICASOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDSSPAINSRI LANKASUDANSURINAMESVALBARD AND JAN MAYENSWAZILANDSWEDENSWITZERLANDSYRIAN ARAB REPUBLICTAIWAN, PROVINCE OF CHINATAJIKISTANTANZANIA, UNITED REPUBLIC OFTHAILANDTIMOR-LESTETOGOTOKELAUTONGATRINIDAD AND TOBAGOTUNISIATURKEYTURKMENISTANTURKS AND CAICOS ISLANDSTUVALUUGANDAUKRAINEUNITED ARAB EMIRATESUNITED KINGDOMUNITED STATES MINOR OUTLYING ISLANDSURUGUAYUZBEKISTANVANUATUVATICAN CITY STATEVENEZUELA, BOLIVARIAN REPUBLIC OFVIET NAMVIRGIN ISLANDS, BRITISHVIRGIN ISLANDS, U.S.WALLIS AND FUTUNAWESTERN SAHARAYEMENZAMBIAZIMBABWE Address Line 1 * Address Line 2 City/Town * Region/State * - Select -AlabamaAlaskaAlbertaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNorthwest TerritoriesNova ScotiaOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingYukonOther (non-U.S./Canada) - Please type your Region/State below. Region/State Other (non-U.S./Canada) - Please type your Region/State below. Postal Code * Country * - Select -UNITED STATESAFGHANISTANALAND ISLANDSALBANIAALGERIAAMERICAN SAMOAANDORRAANGOLAANGUILLAANTARCTICAANTIGUA AND BARBUDAARGENTINAARMENIAARUBAAUSTRALIAAUSTRIAAZERBAIJANBAHAMASBAHRAINBANGLADESHBARBADOSBELARUSBELGIUMBELIZEBENINBERMUDABHUTANBOLIVIABOSNIA AND HERZEGOVINABOTSWANABOUVET ISLANDBRAZILBRITISH INDIAN OCEAN TERRITORYBRUNEI DARUSSALAMBULGARIABURKINA FASOBURUNDICAMBODIACAMEROONCANADACAPE VERDECAYMAN ISLANDSCENTRAL AFRICAN REPUBLICCHADCHILECHINACHRISTMAS ISLANDCOCOS (KEELING) ISLANDSCOLOMBIACOMOROSCONGOCONGO, THE DEMOCRATIC REPUBLIC OF THECOOK ISLANDSCOSTA RICACOTE D'IVOIRECROATIACUBACYPRUSCZECH REPUBLICDENMARKDJIBOUTIDOMINICADOMINICAN REPUBLICECUADOREGYPTEL SALVADOREQUATORIAL GUINEAERITREAESTONIAETHIOPIAFALKLAND ISLANDS (MALVINAS)FAROE ISLANDSFIJIFINLANDFRANCEFRENCH GUIANAFRENCH POLYNESIAFRENCH SOUTHERN TERRITORIESGABONGAMBIAGEORGIAGERMANYGHANAGIBRALTARGREECEGREENLANDGRENADAGUADELOUPEGUAMGUATEMALAGUERNSEYGUINEAGUINEA-BISSAUGUYANAHAITIHEARD ISLAND AND MCDONALD ISLANDSHONDURASHONG KONGHUNGARYICELANDINDIAINDONESIAIRAN, ISLAMIC REPUBLIC OFIRAQIRELANDISLE OF MANISRAELITALYJAMAICAJAPANJERSEYJORDANKAZAKHSTANKENYAKIRIBATIKOREA, DEMOCRATIC PEOPLE'S REPUBLIC OFKOREA, REPUBLIC OFKUWAITKYRGYZSTANLAO PEOPLE'S DEMOCRATIC REPUBLICLATVIALEBANONLESOTHOLIBERIALIBYAN ARAB JAMAHIRIYALIECHTENSTEINLITHUANIALUXEMBOURGMACAOMACEDONIA, THE FORMER YUGOSLAV REPUBLIC OFMADAGASCARMALAWIMALAYSIAMALDIVESMALIMALTAMARSHALL ISLANDSMARTINIQUEMAURITANIAMAURITIUSMAYOTTEMEXICOMICRONESIA, FEDERATED STATES OFMOLDOVA, REPUBLIC OFMONACOMONGOLIAMONTENEGROMONTSERRATMOROCCOMOZAMBIQUEMYANMARNAMIBIANAURUNEPALNETHERLANDSNETHERLANDS ANTILLESNEW CALEDONIANEW ZEALANDNICARAGUANIGERNIGERIANIUENORFOLK ISLANDNORTHERN MARIANA ISLANDSNORWAYOMANPAKISTANPALAUPALESTINIAN TERRITORY, OCCUPIEDPANAMAPAPUA NEW GUINEAPARAGUAYPERUPHILIPPINESPITCAIRNPOLANDPORTUGALPUERTO RICOQATARREUNIONROMANIARUSSIAN FEDERATIONRWANDASAINT BARTHELEMYSAINT HELENASAINT KITTS AND NEVISSAINT LUCIASAINT MARTINSAINT PIERRE AND MIQUELONSAINT VINCENT AND THE GRENADINESSAMOASAN MARINOSAO TOME AND PRINCIPESAUDI ARABIASENEGALSERBIASEYCHELLESSIERRA LEONESINGAPORESLOVAKIASLOVENIASOLOMON ISLANDSSOMALIASOUTH AFRICASOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDSSPAINSRI LANKASUDANSURINAMESVALBARD AND JAN MAYENSWAZILANDSWEDENSWITZERLANDSYRIAN ARAB REPUBLICTAIWAN, PROVINCE OF CHINATAJIKISTANTANZANIA, UNITED REPUBLIC OFTHAILANDTIMOR-LESTETOGOTOKELAUTONGATRINIDAD AND TOBAGOTUNISIATURKEYTURKMENISTANTURKS AND CAICOS ISLANDSTUVALUUGANDAUKRAINEUNITED ARAB EMIRATESUNITED KINGDOMUNITED STATES MINOR OUTLYING ISLANDSURUGUAYUZBEKISTANVANUATUVATICAN CITY STATEVENEZUELA, BOLIVARIAN REPUBLIC OFVIET NAMVIRGIN ISLANDS, BRITISHVIRGIN ISLANDS, U.S.WALLIS AND FUTUNAWESTERN SAHARAYEMENZAMBIAZIMBABWEOther... Country Other... Is this a Post Office address? Yes, the above address is a Post Office Address If selected, we will be mailing your visa interview documents to you by Federal Express. Below, please provide a non-Post Office address (residence or business) where you will be able to receive a Federal Express delivery between the dates of October 15th and October 31st. Address Line 1 - For FedEx Delivery * Address Line 2 - For FedEx Delivery City/Town - For FedEx Delivery * Region/State - For FedEx Delivery * - Select -AlabamaAlaskaAlbertaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNorthwest TerritoriesNova ScotiaOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingYukonOther (non-U.S./Canada) - Please type your Region/State below. Region/State - For FedEx Delivery Other (non-U.S./Canada) - Please type your Region/State below. Postal Code - For FedEx Delivery * Country - For FedEx Delivery * - Select -UNITED STATESAFGHANISTANALAND ISLANDSALBANIAALGERIAAMERICAN SAMOAANDORRAANGOLAANGUILLAANTARCTICAANTIGUA AND BARBUDAARGENTINAARMENIAARUBAAUSTRALIAAUSTRIAAZERBAIJANBAHAMASBAHRAINBANGLADESHBARBADOSBELARUSBELGIUMBELIZEBENINBERMUDABHUTANBOLIVIABOSNIA AND HERZEGOVINABOTSWANABOUVET ISLANDBRAZILBRITISH INDIAN OCEAN TERRITORYBRUNEI DARUSSALAMBULGARIABURKINA FASOBURUNDICAMBODIACAMEROONCANADACAPE VERDECAYMAN ISLANDSCENTRAL AFRICAN REPUBLICCHADCHILECHINACHRISTMAS ISLANDCOCOS (KEELING) ISLANDSCOLOMBIACOMOROSCONGOCONGO, THE DEMOCRATIC REPUBLIC OF THECOOK ISLANDSCOSTA RICACOTE D'IVOIRECROATIACUBACYPRUSCZECH REPUBLICDENMARKDJIBOUTIDOMINICADOMINICAN REPUBLICECUADOREGYPTEL SALVADOREQUATORIAL GUINEAERITREAESTONIAETHIOPIAFALKLAND ISLANDS (MALVINAS)FAROE ISLANDSFIJIFINLANDFRANCEFRENCH GUIANAFRENCH POLYNESIAFRENCH SOUTHERN TERRITORIESGABONGAMBIAGEORGIAGERMANYGHANAGIBRALTARGREECEGREENLANDGRENADAGUADELOUPEGUAMGUATEMALAGUERNSEYGUINEAGUINEA-BISSAUGUYANAHAITIHEARD ISLAND AND MCDONALD ISLANDSHONDURASHONG KONGHUNGARYICELANDINDIAINDONESIAIRAN, ISLAMIC REPUBLIC OFIRAQIRELANDISLE OF MANISRAELITALYJAMAICAJAPANJERSEYJORDANKAZAKHSTANKENYAKIRIBATIKOREA, DEMOCRATIC PEOPLE'S REPUBLIC OFKOREA, REPUBLIC OFKUWAITKYRGYZSTANLAO PEOPLE'S DEMOCRATIC REPUBLICLATVIALEBANONLESOTHOLIBERIALIBYAN ARAB JAMAHIRIYALIECHTENSTEINLITHUANIALUXEMBOURGMACAOMACEDONIA, THE FORMER YUGOSLAV REPUBLIC OFMADAGASCARMALAWIMALAYSIAMALDIVESMALIMALTAMARSHALL ISLANDSMARTINIQUEMAURITANIAMAURITIUSMAYOTTEMEXICOMICRONESIA, FEDERATED STATES OFMOLDOVA, REPUBLIC OFMONACOMONGOLIAMONTENEGROMONTSERRATMOROCCOMOZAMBIQUEMYANMARNAMIBIANAURUNEPALNETHERLANDSNETHERLANDS ANTILLESNEW CALEDONIANEW ZEALANDNICARAGUANIGERNIGERIANIUENORFOLK ISLANDNORTHERN MARIANA ISLANDSNORWAYOMANPAKISTANPALAUPALESTINIAN TERRITORY, OCCUPIEDPANAMAPAPUA NEW GUINEAPARAGUAYPERUPHILIPPINESPITCAIRNPOLANDPORTUGALPUERTO RICOQATARREUNIONROMANIARUSSIAN FEDERATIONRWANDASAINT BARTHELEMYSAINT HELENASAINT KITTS AND NEVISSAINT LUCIASAINT MARTINSAINT PIERRE AND MIQUELONSAINT VINCENT AND THE GRENADINESSAMOASAN MARINOSAO TOME AND PRINCIPESAUDI ARABIASENEGALSERBIASEYCHELLESSIERRA LEONESINGAPORESLOVAKIASLOVENIASOLOMON ISLANDSSOMALIASOUTH AFRICASOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDSSPAINSRI LANKASUDANSURINAMESVALBARD AND JAN MAYENSWAZILANDSWEDENSWITZERLANDSYRIAN ARAB REPUBLICTAIWAN, PROVINCE OF CHINATAJIKISTANTANZANIA, UNITED REPUBLIC OFTHAILANDTIMOR-LESTETOGOTOKELAUTONGATRINIDAD AND TOBAGOTUNISIATURKEYTURKMENISTANTURKS AND CAICOS ISLANDSTUVALUUGANDAUKRAINEUNITED ARAB EMIRATESUNITED KINGDOMUNITED STATES MINOR OUTLYING ISLANDSURUGUAYUZBEKISTANVANUATUVATICAN CITY STATEVENEZUELA, BOLIVARIAN REPUBLIC OFVIET NAMVIRGIN ISLANDS, BRITISHVIRGIN ISLANDS, U.S.WALLIS AND FUTUNAWESTERN SAHARAYEMENZAMBIAZIMBABWEOther... Country - For FedEx Delivery Other... Email Address * Telephone Number (including country code) * Skype ID * Please provide a Skype ID so that a selection committee member may arrange a video conference with you. Biographical Information Gender * - Select -MaleFemale Your Height (needed for garden tool size) * Inches or Centimeters * Inches Centimeters Age * - Select -18192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100 Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017 Marital Status * - Select -SingleMarriedDivorced Do you have children? * - Select -YesNo Do you have friends or family that rely on you for financial support? * Yes No If "Yes", how will those you support support themselves while you are gone? * Are you aware that your visa category (J-1 non-immigrant) does not permit you to have a job while in the U.S.? * Yes No I am able to contribute: * $ U.S. toward the cost of my internship. What is your native (primary) language? * - Select -EnglishOther... Please specify your native (primary) language * Please rate your English skills from 1 (limited) to 10 (very strong): Listening * - Select -12345678910 Speaking * - Select -12345678910 Reading * - Select -12345678910 Writing * - Select -12345678910 More About You In 4-6 sentences each, please describe: Yourself: Why are you interested in food sovereignty issues and how do you intend to use the knowledge gained during this internship to benefit others in your community? * Your farming experience: * Your professional experience, including any teaching experience: * In your current position, how much of your time is spent in each of the below roles? Please provide a value of 0 (none of my time) - 10 (all off my time) for each role: Administration: * - Select -012345678910 Teaching and/or knowledge sharing within your organization: * - Select -012345678910 Knowledge sharing outside of your organization: * - Select -012345678910 Hands-on food growing: * - Select -012345678910 Please share one experience where you demonstrated leadership: * Please share a time when you turned a challenging situation into a positive outcome: * How do you learn best? * How many hours per week do you typically work? Are you comfortable with the long hours of often physical work that managing a mini-farm full-time often requires? * How do you feel about being away from family and friends for 8 months? Are you okay with not having regular communications with them (internet is available at all training sites)? * What do you consider your areas of expertise? What are your greatest skills? What skills or expertise do you want to gain? * What do you like to do in your free time? * Please describe the organizations and/or communities that you currently work with: * When you return from your internship, will you continue to do work with your present community or organization, or will you be returning to accomplish something else? If something else, what? * What do you hope to be doing in 10 years? * Please Describe Your Experience with the GROW BIOINTENSIVE Method How did you hear about this internship? * No GROW BIOINTENSIVE experience I have no experience with GROW BIOINTENSIVE, but I am interested in an internship. Have you read "How to Grow More Vegetables..." by John Jeavons? * Yes No Have you read the GROW BIOINTENSIVE Farmer's Mini-Handbook? * Yes No View and download at: www.growbiointensive.org/PDF/FarmersHandbook.pdf Have you attended GROW BIOINTENSIVE training? * No Ecology Action 3-Day Workshop in Willits, CA Other (Please describe your training below.) Have you attended GROW BIOINTENSIVE training? Other (Please describe your training below.) Are you currently using GROW BIOINTENSIVE growing methods? * Yes No Please describe the specific GROW BIOINTENSIVE practices that you are currently using: * Mini-Bio: * Please write a brief biography about yourself which will be published in Ecology Action's Internship Handout should you be accepted into the program. Please be sure to include: 1) why you are interested in food sovereignty issues and the GROW BIOINTENSIVE method of food raising and 2) how you intend to use the information you learn in this program to influence others and help your community upon program completion. How does GROW BIOINTENSIVE fit into your future work plans? * Learning Through Internship What 5 specific things would you like to learn during this internship? * Are you comfortable with: Learning in a classroom setting for up to 8 hours per day? * Yes No Doing physical work outside for up to 8 hours per day? * Yes No Sharing a room and living in rustic conditions? * Yes No Dietary Information Do you have any specific dietary requirements? * Please review the "Program Sites" tab on: growbiointensive.org/Internship/8Month.html before proceeding. Please note that Ecology Action's three training sites have different dietary restrictions: Ecology Action Headquarters (Common Ground Mini-Farm & Research Garden) is a vegetarian site (No meat, including fish, is allowed on this site. Eggs and dairy are allowed). Victory Gardens for Peace Mini-Farm is a vegan site (No animal products are consumed on the site. No meat, eggs, or dairy are allowed on this site). Golden Rule Community Garden allows the consumption of meat and animal products, but also provides vegan, gluten-free and vegetarian meal options. Site Preferences Please rank the research sites according to your preferred internship locations. Ecology Action Headquarters (Common Ground Mini-Farm and Research Garden), Willits, CA * Strongly Favor Somewhat Favor Neutral Somewhat Opposed Strongly Opposed Victory Gardens for Peace Mini-Farm, Mendocino, CA * Strongly Favor Somewhat Favor Neutral Somewhat Opposed Strongly Opposed Golden Rule Community Garden, Willits, CA * Strongly Favor Somewhat Favor Neutral Somewhat Opposed Strongly Opposed Travel Information Medical insurance coverage valid in the U.S. will be required during your stay. Please tell us: * I will provide my own medical insurance during my stay. I will need Ecology Action to provide me with insurance coverage during my stay. If you are providing your own insurance, a minimum coverage level of $1,000,000 USD is required. Please list all international airports (and their corresponding cities) that you will be able to depart from and return to. * Medical/Insurance Information Because the 8-month Internship Program can involve strenuous exercise, rustic living conditions and rugged terrain, we ask that you provide some basic information regarding your health and your ability to pay for any medical care that might be required if you should sustain an injury in the course of this program. If accepted to this program, you will be required to fill out a hardcopy of our Release Form and Waiver, and U.S. citizens will be required to provide proof of medical insurance. Non-U.S. citizens will be required to purchase international insurance for the duration of the internship (Ecology Action will facilitate this process for accepted applicants). Be assured that we only use the information submitted to make sure all of our interns have the best possible experience. We will never divulge any of your information to anyone, for any reason. Do you have a heart condition, back condition, or other present and/or pre-existing conditions that could limit your full participation in the physical activities of this internship? * - Select -YesNo Please list any medications you are taking * Date of last medical examination * I have major/catastrophic medical insurance coverage * - Select -YesNo Medical Report Acknowledgement I confirm that a doctor has completed my Medical Report Form and that I have attached the completed form to my application. * - Select -YesNo I understand that without a completed Medical Report Form, my application will not be considered. Health and Liability Waiver: I hereby certify that I am in good physical condition and do hereby release, acquit and discharge ECOLOGY ACTION, its staff, officers and members, of any and all claims, causes of action or damages whatsoever, in any way arising out of or in any manner connected with their program or any medical treatment rendered in event of need. I understand that I am responsible for the coverage of any medical expenses during my time at, or resulting from my activities with Ecology Action. I understand and agree to the terms of the above waiver. * Yes No Please read carefully and select the checkbox to indicate that you understand and agree to the terms of the above waiver. If you are accepted to the program, you will be required to fill out a hardcopy of our Release Form and Waiver, and, if you are from the U.S., provide proof of insurance. Failure to do so will prevent admittance into the program. Would you like to receive email notifications about top-breaking local and global news and related solutions, release of new online training videos, and special workshops? Yes, please!No, thank you! Would you be interested in receiving Ecology Action's triannual e-Newsletter? Yes, please!No, thank you! We appreciate your interest in the work of Ecology Action. Since 1972, we have been helping millions of people worldwide empower themselves to better health and the regeneration of the soil that feeds us through teaching and demonstrating the GROW BIOINTENSIVE method. Information that you provide in this form is for Ecology Action’s use only and will never be shared with or sold to other organizations. If you sign up for email updates or our e-newsletter, you can ask to be removed from our mailing lists at any time.
