YOUTH PROGRAMS INTEREST FORM - SUMMER 2024
Stipend Based Appreticeships
SRBCC offers programs designed to engage and support young people in their personal, social, and educational development. Our Arts Apprenticeships pay stipends to youth that meet all attendance and participation requirements. Providing stipends supports the economic equity of youth, families, and communities by reducing financial barriers for youth to participate in programming, promoting youth financial literacy and economic mobility.
Student's Name
*
First Name
Last Name
Age
*
Please Select
14
15
16
17
18
19
20
21
22
23
24
E-mail
*
example@example.com
Zip code
*
What pronouns do you use?
*
She/her/her
He/him/his
They/them/their
Ze/hir/hir
Are you currently in School?
*
Please Select
Yes, I'm currently a High School Student
No, I am not currently in School
If you are currently attending school, please tell us where
Which of our programs are you interested in attending?
*
Urban Gardening - designed to empower and educate youth ages 15 to 24 about the benefits of sustainable food production, environmental conservation, and healthy lifestyles.
Tell us a little more about you: Why are you interested in this program? :
*
0/400
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Parents Contact Information
This section is MANDATORY for all applicants under 18 years old
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Emergency Contact Person #1
First Name
Last Name
Emergency Contact Person #1 Phone Number
Please enter a valid phone number.
Emergency Contact Person #2
First Name
Last Name
Emergency Contact Person #2 Phone Number
Please enter a valid phone number.
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