Full Name (required):

Age (required):

Street Address (required):

City (required):

State (required):

Zip Code (required):

Your Best Phone (required):

Your Email (required):

Parent/Guardian Name (required):

His / Her Best Phone (required):

His / Her Email (required):

School in Fall (required):

Grade in Fall (required):

The following information is confidential. It will only be reviewed by the Selection Committee.

What neighborhood do you live in? (required):

Ethnicity:

Sexual Orientation:

Family Income Level:

How would you get to the program?

—Please choose an option—BUS/BARTCARWALK

How did you hear about the Summer Arts Apprenticeship? (please check all that apply)

FriendTeacher / CounselorFacebookFormer ParticipantYouth OrganizationOther

If Youth Organization, which one?

If Other, please list

The Summer Arts Apprenticeship requires a full commitment of time and energy and a minimum of 80 hours. Can you commit to attending ALL the sessions?

YESNO

Is there anything that would prevent you from attending?

ESSAY QUESTIONS:
PLEASE ANSWER ALL of the questions (three sentences per question recommended).

1. What is your experience in dance or performance?

2. What do you hope to gain from the Summer Arts & Activism Apprenticeship?

3. What type of activism or issue are you interested in (i.e. immigration, education, health, community need, etc.)? Why is this issue important to you?

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