Youth Program Application Form 2021

Youth Program Application Form

2021
Student Name

First Name Last Name
Birth Date
School
Parents Names

First Name Last Name
Name

First Name Last Name
Email
example@example.com
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Students Interests/Hobbies:

Reading Playing Sports Creative Writing Crafting Art Dance
How Did You Hear About Our Program?

Student Teacher Parent Public Advertisement Social Media
Letter of interest (to be written by student) - Please write 5-7 sentences explaining why you want to be apart of PWI.
What would you like for your student to gain from our youth program?
AS A PART OF PHENOMENAL WOMEN, INC.: We expect all students to represent the organization, values and mission to the best of their ability, attend at least five sessions in order to successfully complete the program, actively participate, engage in activities, respect their peers, volunteers and mentors.

By signing and submiting this application the students and parents are adhering to these expectations.
Signature

Clear
Should be Empty:

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