Career Development Program Application
Please complete this form to apply for the student career development program. Both students and parents/guardians should provide the requested information.
Section 1: Student Information
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Current Grade
*
Please Select
9th Grade
10th Grade
11th Grade
12th Grade
Other
School Name
*
City
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Section 2: Parent/Guardian Information
Parent/Guardian Name
*
First Name
Last Name
Relationship to Student
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Preferred Contact Method
*
Phone
Email
Text Message
Section 3: Career Pathway Selection
Career Pathway Selection
*
HVAC
Information Technology / Cybersecurity (Wait List)
Finance & Accounting
Entrepreneurship
Barbering
Section 4: Student Questions
Why do you want to join this program?
*
What career are you most interested in pursuing?
*
What are your goals after high school?
*
Describe a challenge you have overcome.
*
Section 5: Eligibility Verification
Eligibility Verification
*
I currently maintain satisfactory grades.
I am willing to participate in monthly mentorship sessions.
I understand that attendance and respectful behavior are required.
Section 6: Uploads
Most recent report card (PDF or photo)
Upload a File
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of
Recommendation Letter #1 (You may upload a letter, email, or any communication from reference)
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Recommendation Letter #2 (You may upload a letter, email, or any communication from reference)
Upload a File
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of
Section 7: Parent Consent
I give permission for my child to participate in the Love In Action Foundation Career Development & Mentorship Program. I understand that participation requires consistent attendance, respectful conduct, and communication with program staff.
Date
*
-
Month
-
Day
Year
Date
Signature
Submit Application
Submit Application
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