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
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Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
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2015
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2012
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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: