YC Application

Student Information

Student Name*

Please put N/A if you do not have a middle name.

First Middle Last

Student Preferred Name/Nickname*

Birthday*

Age*

Home Address*

Street Address Address Line 2 City State ZIP Code

Student Cell Phone*

Home Phone

Student Email Address*

Student email only. NO school or Parent/Caregiver email.

Gender*

Male

Female

Prefer not to answer

Race/Ethnicity*

Please select all that apply.

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

White or Caucasian

Parent/Caregiver Information

Parent/Caregiver Name*

First Last

Relationship to Student*

Parent/Caregiver Home Address*

Street Address Address Line 2 City State ZIP Code

Parent/Caregiver Cell Phone*

Parent/Caregiver Email Address*

Occupation and place of employment*

Parent/Caregiver Information 2

Parent/Caregiver 2 Name

First Last

Relationship to you

Parent/Caregiver 2 Home Address

Street Address Address Line 2 City State ZIP Code

Parent/Caregiver 2 Cell Phone

Parent/Caregiver 2 Email Address

Must be different than above Parent/Caregiver email

Occupation and place of employment

Transportation*

I can get transportation to and from each session:

Yes

No

Physical Activities*

Is there any reason that you would be unable to be involved in activities such as a ropes course, community service projects or any other physical activity, either with or without accommodations?

Yes

No

Please explain*

How did you hear about Youth Corps?*

If any YC Students and/or YC Alumni referred you, please include their name.

School Information

Current Grade*

Current School*

School Attending Fall 2023*

Current Grade Point Average*

Most Recent Report Card*

Max. file size: 1 MB.

Organizations & Activities

Please list up to five school, volunteer, religious, social, athletic, or other activities/organizations in which you've participated.*

(Include organization or activity; your grade in school at the time; brief description of your role.)

Work Experience

List any job experience, paid or volunteer, and briefly explain what it involved:*

Do you currently have a job?*

Yes

No

How many hours per week?*

Would your job interfere with the Youth Corps program?*

Yes

No

YC Questionnaire

Who is your hero or heroine (someone you admire)? Why?*

What are your hobbies and interests?*

Please explain what you hope to gain by participating in Youth Corps.*

What are your long-term and career goals?*

What do you think are the 3 best things about your hometown and why?*

Identify the 3 most significant problems facing Richland & Lexington Counties and describe your solutions.*

To complete your application:

Please list the name of one person whom you have asked to be a reference for you (other than a parent, friend, or relative). We will email your reference a link to the Reference Form. Your application is NOT COMPLETE until we have received a completed Reference Form.

Name of Reference:*

Prefix First Last

How does this person/reference know you?*

Reference Email*

We will email your reference a link to the Reference Form.

Reference Phone*

I understand that my Youth Corps Application is INCOMPLETE and I will not be scheduled to interview until my reference has submitted a Reference Form on my behalf.*

Yes, I understand.

BY TYPING IN MY NAME BELOW, I AM DECLARING THAT I AM THE PERSON WHO FILLED OUT THIS APPLICATION.*

First Last

YC Application

Student Information

Parent/Caregiver Information

Parent/Caregiver Information 2

School Information

Organizations & Activities

Work Experience

YC Questionnaire

To complete your application:

Unleash your Potential