Summer REACH Internship Application
Student Name
*
First Name
Middle Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
*
Please Select
Male
Female
N/A
Email address (Do not use your school email address)
*
example@example.com
REACH Applicant Cell Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mother/Guardian Name
*
First Name
Last Name
Mother/Guardian Phone
*
E-mail
*
example@example.com
Father/Guardian Name
First Name
Last Name
Father/Guardian Phone Number
Please enter a valid phone number.
Father/Guardian Email
example@example.com
Emergency Contacts
*
Name and Contact Number
Emergency Contacts
*
Name and Contact Number
School information: I understand that the YWCA Knoxville will obtain school information for each REACH participant. This information will be used for data collection by the organization.
School (during 2021-22 school year)
*
Homeroom Teacher (during 2021-22 school year)
*
Medical Information
Medications taken throughout the day: (Enter N/A if this does not apply)
*
Allergies or Asthma: (Enter N/A if this does not apply)
*
List any emotional or physical challenges: (Enter N/A if this does not apply)
*
Guidelines for REACH Internship
As a REACH intern, I agree to abide by the following expectations:
Please check the boxes next to the statements to indicate that you have read and understand the statements below:
*
Arrive daily at 10AM and stay until 2PM.
On all days, be on time, take initiative, and do your best.
Complete timesheet daily.
Be a positive and helpful role model for campers.
Be respectful and assist staff in routine activities (collecting materials for lessons, distributing snacks, and maintaining clean areas).
I understand that my attendance may impact my stipend.
I understand that this is a stipend and not a paycheck.
Student Signature:
Submit
Should be Empty: