2021 Summer at City Hall Application Thank you for your Interest in Summer at City Hall Please complete the following application. You will be contacted with more information the week of April 19th 2021. OK Question Title * Personal Information First and Last Name * Address * City/Town * State/Province * ZIP/Postal Code * Email Address Cell Phone Number * Hme Phone Number * OK Question Title * Date of Birth Date Date OK Question Title * Current Grade in School (as of Fall 2021) Junior Senior OK Question Title * Will you be at least 15 years old on June 8th, 2021? Yes No OK Question Title * Current School Attending Buckingham Charter Will C. Wood Vacaville High Vanden High Kimme Work Readiness and Alternative Pathway (W.R.A.P) Travis Education Center (TEC) OK Question Title * School District Travis Unified School District Vacaville Unified School District OK Question Title * Emergency Contact #1 Name Address City/Town State/Province ZIP/Postal Code Phone Number Relationship OK Question Title * Emergency Contact #2 Name Address City/Town State/Province ZIP/Postal Code Email Address Relationship OK Question Title * Job/Internship/Volunteer - Please list any job, internship or volunteer experience you have below.Experience #1 Company/Organization Position Start/End Date Reason for Leaving Paid or Volunteer? OK Question Title * Job/Internship/Volunteer - Please list any job, internship or volunteer experience you have below.Experience #2 Company/Organization Position Start/End Date Reason for Leaving Paid or Volunteer? OK Question Title * Job/Internship/Volunteer -Please list any job, internship or volunteer experience you have below.Experience #3 Company/Organization Position Start/End Date Reason for Leaving Paid or Volunteer? OK Question Title * Please list 3 professional references below. References can include: teachers, coaches, employment supervisors, mentors etc. Please do not list family members.Reference #1 Name Relationship Email Address Phone Number OK Question Title * Please list 3 professional references below. References can include: teachers, coaches, employment supervisors, mentors etc. Please do not list family members.Reference #2 Name Relationship Email Address Phone Number OK Question Title * Please list 3 professional references below. References can include: teachers, coaches, employment supervisors, mentors etc. Please do not list family members.Reference #3 Name Relationship Email Address Phone Number OK SUBMIT
