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YC Application
YC Application
Application MUST be filled out by student.
"
*
" indicates required fields
Step
1
of
5
20%
Student Information
Student Name
*
Please put N/A if you do not have a middle name.
First
Middle
Last
Student Preferred Name/Nickname
*
Birthday
*
MM slash DD slash YYYY
Age
*
Home Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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
*
8th
9th
10th
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:
*
Dr.
Miss
Mr.
Mrs.
Ms.
Mx.
Prof.
Rev.
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
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