Shore Corps Leader Application

Shore Corps Leader

You must be 18 to 25 years old and interested in serving as summer staff for Shore Corps.
Full Name*

First NameLast Name
Gender*
Ethnicity
Birth Date*

MonthDayYear
E-mail*
example@example.com
Cell Number*
Format: (000) 000-0000.
Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / ZIP Code
Name of School
Have you participated in RISE programs before?*
If yes, what RISE programs and/or events?
Lifeguard CertificationCPR CertificationOther
Additional Skills
Cohort ID
Program ID
CertificationsOLD
FemaleMaleNonbinaryOther
American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoHawaiian or Other Pacific IslandWhiteOther
Birth date map field
Should be Empty: