Charleston County Human Services Commission Summer Youth Works! 2014 Application Name: ________________________________________________
Date: _____________________
Address:
Email:_______________________________________________________________________________
Phone: _____________________________ Alternative Phone: ______________________________ County where you live:
Berkeley
Charleston
Dorchester
Emergency Contact: ______________________________ Phone: ____________________________ How much work experience do you have?
None
1-6 months
One Year
1+ yrs
Have you applied for Summer Youth Works! in the past? _______________________ What high school or college are you now attending? _____________________________________________________________________________________ What is your status:
High School Junior
What is your current GPA: ______________
High School Senior
College Student
How many people live in your home: _________