Summer Star Application 2019

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* 1. Full Name

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* 2. School

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* 3. Grade (Present)

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* 4. Age

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* 5. Birth date

Date / Time

Date

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* 6. Student's Address

Address

City/Town

State/Province

ZIP/Postal Code

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* 7. Phone Number

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* 8. Email

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* 9. Parent/Guardian's Name

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* 10. Relationship to Student

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* 11. Parent/Guardian's Phone Number

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* 12. Why are you interested in STAR?

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* 13. Tell us about three of your strengths or things you are good at.

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* 14. What do you think students your age need to know about relationships?

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* 15. We are looking for student leaders to be part of this program. Tell us about a situation in which you felt you were a leader. Tell us what you did.

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* 16. Summer STAR runs from July 8, 2019 through August 15, 2019. Participants meet Monday-Thursday from 1pm-5pm. If you were accepted into this program, is there anything that would make it difficult for you to make this commitment? Yes or no? If yes please explain.

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* 17. What is one idea you have for an event to help educate your peers about what you learned?

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* 18. I am connected with Jane Addams Place

Yes

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* 19. Take a picture & Upload a copy of your birth certificate.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 20. Take a picture & Upload a copy of your Social Security Card.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 21. Take a picture & Upload a copy of your ID (State or School)

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 22. Take a picture & Upload a copy of your Blue working papers (If under the age of 18).

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File