2022-23 SLA Youth Registration Form

2022-23 SLA Youth Registration Form
Registration forms gather information about student participants essential to the operation of SLA, information will be used to improve and grow SLA programming. SLA may use data to measure your academic progress and we do not share, sell, rent or trade personally identifiable information with third parties for their promotional purposes.

Caretaker Information
Parent/Primary Caregiver Name: *

First Name Last Name
Mobile Number *

Area Code Phone Number
Parent/Primary Caregiver Email *
example@example.com
Parent Address *

Street Address

Street Address Line 2

City

Zip Code
Parent/Primary Caregiver Employment Status *
Employer Name or Self-Employed Company Name *
Type N/A if Disabled or Unemployed.
Parent/Primary Caregiver's (current or past) Job/Occupation *
i.e. CEO, Caregiver, Doctor, Lawyer, Baker, News Anchor, TV Personality, etc.
How many people are in your Household? *
Please include Head of Household.
How many in your Household are under the age of 18y/o? *
EMERGENCY CONTACT
In case of an emergency, and I cannot be reached, please contact: *

First Name Last Name
Emergency Contact Person (listed above) Mobile NumberPhone Number *

Area Code Phone Number

Student Interest and Skill Survey

Please answer each question to the best of your ability.
1. What are your current interests and hobby? *
2. What special skills or talents do you have? *
3. What jobs are you interested in pursing as a career? *
4. Can you mention a skill you believe is the most important for your future job success?
5. In the order most of preferred to least, please rank the following 10 areas of interest you would like to participate in during this program: Research and Development, Project Management, Copy Creating/Editing, Presentation, Website, Budget & Finance, Marketing, Fundraising, Data Management, and Communications. *
6. Please tell us why you would like to participate in Superhero Leadership Academy SECT & Internship Program? *
SECT - Social Entrepreneurial Civic & Technologies Club
7. How do you feel being a part of this leadership and development program will help you in the future? *

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Student Information