Back to Senator Snowe's Homepage
UNITED STATES SENATE
PAGE PROGRAM
CONFIDENTIAL APPLICATION FOR ADMISSION
This application must be completed fully to be eligible for consideration. Please print or type.
Semester preference: specify first, second and third choices. ______Fall _____ Spring _____ Summer
Applicant
Name
Home Address
Home ( ) Fax ( ) E-mail
Birthdate Current Age Country of Birth
Country (ies) in which citizenship is held
Social Security Number Present grade in school
Parents
Name of parent/guardian
If guardian, relationship to applicant
Home address (if different from applicant’s)
Home ( ) Work ( ) E-mail
Name of parent/guardian
If guardian, relationship to applicant
Home address (if different from applicant’s)
Home ( ) Work ( ) E-mail
Recommendations
From what sources have you heard of the Senate Page Program?
Please list any relatives or friends who have served as Senate Pages.
Name:
Year:
Relationship:
Schools
Name of present school
Address
Telephone ( )
Dates of Attendance
Cumulative grade point average following the most recently completed semester
Current class enrollment
Former Schools (list in order, beginning with most recent):
School Address Dates Attended
Signatures (Required)
SIGNATURE OF PARENTS OR GUARDIAN
SIGNATURE OF APPLICANT
Date of Application
Policy and Notice
NON-DISCRIMINATION: The Senate Page Program does not discriminate on the basis of race, religion, disability, gender, national or ethnic origin in administration of its admission or other policies.
Additional Information
Please type your answers to the following questions on a separate standard size sheet of paper. Type your name and the current date at the top of each page.
1. What inspired you to apply to the Senate Page Program? What do you expect to gain from the Page experience?
2. What aspect of the Senate Page Program, e.g., the legislative process or working in Washington, D.C., particularly interests you? How would you intend to take advantage of that aspect if you become a Page?
3. Describe your interest in any of the activities listed below:
Art, Science Clubs, Organizations
Music, Athletics, Debating, Public Speaking
Dramatics, School Publications, Summer Experience (camp, travel)
Dance, Student Government, Jobs (paid or volunteer)/Community Service
4. Have you ever spent time away from home? Did you attend boarding school, camp, foreign exchange program, gifted and talented summer program or something other? Please explain.
5. Have you been disciplined by your school administration for any reason in the last two years? If so, please explain.
6. Have you ever been arrested? If so, for what offense? What was the disposition of the arrest, e.g., conviction, acquittal, dismissal of charges? (Arrest will not necessarily be a bar to acceptance. Factors such as the disposition, and seriousness and nature of the violation will be taken into account.)
7. List any employment you have had in the last two years, including summer and after-school work.
8. List any awards or honors you have received in the last two years.
Please return application to:
Cheryl Leeman
Office of Senator Olympia J. Snowe
3 Canal Plaza, Suite 601
Portland, ME 04101
UNITED STATES SENATE
PAGE PROGRAM
CONFIDENTIAL SCHOOL RECOMMENDATION
To the Applicant’s Parents
Please complete this section and give this form to the principal or counselor at your child’s school.
(Applicant’s name) has applied to the Senate Page Program.
Signature of Parent or Guardian
(required before school can release grades, test results, and recommendations.)
To the Principal or Counselor
Please feel free to elaborate on an additional sheet of paper. Please return the form with a copy of:
Complete transcript (including current grades)
Teacher’s comments (if available)
Testing results Explanation of marking system
A strong sense of community and individual responsibility is necessary for the success of each page in the program. Your answers to the following questions will help determine the applicant’s potential for success in this community.
Please comment briefly on the applicant’s sense of responsibility.
Please describe the applicant’s relationship with peers.
Have you any reason to doubt the applicant’s honesty? If so, please explain.
Please comment on the applicant’s maturity.
Has the applicant been suspended from school or on disciplinary probation? If so, for what reason?
Has the applicant demonstrated good work and study habits at your school? Please elaborate.
Please comment on the applicant’s attendance record. How many times has the student been tardy and absent during the most recently completed academic semester?
Is there anything else about this applicant which would help us determine potential for success?
Cheryl Leeman
Office of Senator Olympia J. Snowe
3 Canal Plaza, Suite 601
Portland, ME 04101
How would you recommend the candidate for the Senate Page Program?
9 Enthusiastically, with no reservations 9 With reservations (please explain)
9 Confidently 9 Prefer not to recommend
Signature Date
Please print name Title
School
School Address
Telephone ( ) Fax ( )