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Conservation Youth Corps 2014 Application Form
Part One: Applicant Application
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1.
Name:
(Required.)
First Name:
Last Name:
*
2.
Contact Information:
(Required.)
Home Number:
Re-enter Home Number:
Cell Number:
Re-enter Cell Number:
Email Address:
Re-enter Email Address:
*
3.
High School Attending:
(Required.)
*
4.
Address:
(Required.)
Address: (include Unit or Apt #)
City:
Postal Code:
5.
Have you previously participated in the Conservation Youth Corps program?
Yes
No
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6.
Date Availability: (Please check off all weeks in which you are available to participate)
(Required.)
August 18 - 22 (Peel Region Students)
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7.
Safety Boots:
(Required.)
Do you have your own CSA-certified Grade 1 safety boots, identified by a triangular Green Patch? (yes/no)
If not, please indicate your shoe size including whether it is mens or women's:
*
8.
Date of Birth (DD/MM/YYYY):
(Required.)
*
9.
Grade Level Completed as of July 1, 2014: (Particpants must be returning to high school in the Fall of 2014 and must have completed Grade 9 by July 2014.)
(Required.)
Grade 9
Grade 10
Grade 11
Grade 12