LCSD 21st Century After-School Program Application
ALL APPLICATIONS ARE DUE BY AUGUST 31, 2022.
BACKGROUND CHECKS ARE REQUIRED!
Name
First Name
Last Name
Address
Applicant Present Address
Street Address Line 2
City
State
(Zip
Applicant Phone Number
Email
example@example.com
Emergency Contact Name/Phone
Current Work Location/Job Title
Position Applying for
Current AR Teacher Licenses if applicable
Choose an area that you are interested in working.
STEM- Science Technology Engineering Arts and Math Art- History & Culture
Explorer's Club- Bringing Learning to Life Field Lessons (Field trips)- Hands on experiences
Offerings
Physical Activities (Sports)- Healthy choices
Dance (Cheer teams)- Get moving
Applicant's Signature:
Applicant's Signature
Date
/
Month
/
Day
Year
Date
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