2023 Bright Spot Farms
YOUNG FARMERS PROGRAM INTEREST FORM
PERSONAL INFORMATION
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Gender
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Alternate Phone Number
-
Area Code
Phone Number
Email
example@example.com
Emergency Contact
*
First Name
Last Name
Relationship to You
*
Emergency Contact Phone Number
*
-
Area Code
Phone Number
Which sessions are you interested in? (Check all that apply)
*
Spring
Summer
Fall/Winter
Are you a citizen of the United States and/or legally eligible for employment in the United States?
*
Yes
No
Do you have a driver's license?
*
Yes
No
What method(s) of transportation do you have available to get to work? (Check all that apply)
*
Bus
Car (Own)
Ride with relative/friend
Walking
Other
How did you hear about us?
*
EDUCATIONAL INFORMATION
What high school do you attend currently?
*
What grade are you in currently?
*
9th
10th
11th
12th
What is your career pathway (if you have one)? If you don't have a career pathway, what are you interested in?
*
Please list any additional information you would like for us to know:
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