Active Achievers Youth Placement Survey 2026

ACTIVE ACHIEVERS INC.
Youth Placement Survey
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
SCHOOL & GRADE
What school do you currently attend or most recently attended?
What grade are you entering in Fall 2026?
Are you graduating high school this year (Class of 2026)?
What is your current GPA if you know it? If you are not sure, write your best estimate.
Do you have any plans to attend college or a training program after high school?
If yes, what school or program are you interested in? If you are not sure, that is okay -just write what comes to mind.
COLLEGE & CAREER READINESS
Have you completed your FAFSA (Free Application for Federal Student Aid)?
Have you been accepted to a college or training program for Fall 2026?
Have you written a college essay before?
Do you have a resume?
Have you ever had a job, internship, or volunteer experience?
If yes, please describe briefly what you did.
YOUR GOALS & INTERESTS
What are you hoping to get out of this summer program? Check all that apply.
What career fields or industries are you interested in? If you are not sure yet, describe what you enjoy doing.
Is there a specific skill you want to develop or improve this summer?
Do you have any interest in working with young children or in early childhood education?
Would you be interested in earning your Maryland 90-Hour Child Care Certification this summer? This certification qualifies you for paid part-time work in child care during the school year.
AVAILABILITY & LOGISTICS
Are you available Monday through Friday from 9:00am to 3:00pm for the full summer program (June 22 through August 28)?
If you have scheduling conflicts, please describe them here.
Do you have reliable transportation to and from the program site?
Do you have access to a phone or device to receive program communications?
A LITTLE MORE ABOUT YOU
Is there anything going on in your life right now that you think the program should know about in order to support you well? You do not have to share anything you are not comfortable sharing.
What is one thing you want us to know about you that these questions did not ask?
How did you hear about this program?
Should be Empty:

ACTIVE ACHIEVERS INC.

Youth Placement Survey

SCHOOL & GRADE

COLLEGE & CAREER READINESS

YOUR GOALS & INTERESTS

AVAILABILITY & LOGISTICS

A LITTLE MORE ABOUT YOU