Gateway Wellness Center – Summer Youth Employment Program 2026 Interest Form

Gateway Wellness Center – Summer Youth Employment Program 2026 Interest Form

Complete this form to express your interest and be considered for an interview.
Student Information
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
School Name*
Current Grade*
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Which county do you live in?*
Parent/Guardian Information
Parent/Guardian Name*
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Awareness & Contact
Is your parent/guardian aware that you are applying for this program?*

YesNo
Can we contact your parent/guardian if needed?*

YesNo
Availability
Are you available Monday–Thursday from 9:00 AM – 2:00 PM (June–August)?*

YesNo
Work Readiness
Why do you want to join this program?*
Commitment Check
This program requires showing up on time, participating, and completing assigned tasks. Do you agree?*

YesNo
Interview Requirement
If selected, are you willing to attend an in-person interview?*

YesNo
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Student Information