Seeds To Supper Youth Program

ABOUT STS

APPLICATION

PERMISSION
LETTER

SEEDS TO SUPPER SUMMER ENROLLMENT APPLICATION

DIRECTIONS: - To apply you must be 15 years old by July 1, 2003. - If you are under 18 years of age you must obtain either a Student General Employment Certificate or Nonfactory Employment Certificate. - You must be able to attend the entire Summer Program from July 8 through August 14, 2003.

Full Name: _________________________________________________________

Nickname/Name you like to be called: ___________________________

Home Address: ______________________________________________________

City: _________________________ State: _________ ZIP: ________

Home Telephone: (         ) _____________________________________

Gender: __Female;  __Male;   Date of Birth: _______________________

Current Age: ______ Social Security # _______________________________

Parent/ Guardian Name: _______________________________________________

Parent/Guardian Work Telephone (           ) _______________________________

This person is my:   __Mother   __Father   __Legal Guardian   __Relative: ___________

Other Parent/Guardian Name: __________________________________________

Other Parent/Guardian Work Telephone: (          ) ____________________________

This person is my:  __Case Worker   __Mother   __Father   __Relative: ____________

Current School Name: ________________________________________________

School Telephone: (           ) __________________________

Current Grade Level:__9   __10   __11   __12   __Other: ____________________

Name & phone number of an adult who knows you well (not a parent or guardian):

Name: ________________________ Telephone: (           ) _____________________

This person is my:  __Teacher   __Coach   __Employer  __Other: ______________

How did you find out about us? _________________________________________

APPLICATION QUESTIONS :

We want to know who you are! Think carefully about your personal answers to these questions. Write as completely as you can, and try to use all the space provided. You may attach a separate sheet if you need more room.

1. Why do you want to be a member of the Seeds To Supper Program? What interests you about the Program?

2. Tell about a time when you helped someone. What was the situation and what did you do? How did you feel about it?

3. What do you think is hard about working in a team with other people? What is good about working in a team?

4. What would you like to achieve this summer? How can the Seeds To Supper Program help you do that?

Thank you! If there is anything else you would like us to know, feel free to attach another sheet of paper.

Mail your completed form to:

Sixth Street Community Center
638 East 6th Street
New York, NY 10009

After we receive your application, we will contact you for an interview.

If you have any questions you can contact Howard Brandstein or Annette Averette at (212) 677-1863 or email seeds@sixthstreetcenter.org