Intern Application Form

Name:*

First NameLast Name
Birth Date*

MonthDayYear
E-mail Address:*
Parent E-mail Address*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Why are you interested in becoming a Jr. Educator ?*
Please describe your experience working with young children. *
What skills would you like to learn or improve on this summer ?*
Are you able to attend a half day orientation on June 13th from 8am-12pm?*

YesNo
What weeks of summer would you like to be a Jr. Educator ?*

June 17th-21stJune 24th-28thJuly 1st-3rd (no camp July 4th&5th)July 8th-12thJuly 15th-19thJuly 22nd-26thJuly 29th-August 2ndAugust 7th- August 11th
Should be Empty: