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: _________
In August 2014, what school will you be attending?
What is/will be your major in college?
Are you currently involved in any community service?
Yes
No
If yes, please give details:
Do you have membership with any national or local organization(s)?
Yes
No
If yes, give details:
Please share your personal goals for the next 3-5 years:
Please share how you plan to accomplish these goals:
a Project Pride program • 1069 King Street Charleston, SC 29403 • 843-724-6760 phone • 843-724-6787 fax