[City of Sacramento] 2019 Summer @ City Hall Student Application

Student Application

Applications Due Tuesday, April 23, 2019

A program collaborative between City of Sacramento Youth Division, Natomas Unified School District, Sacramento City Unified School District and Twin Rivers Unified School District.

Student Information

Please select the best number to reach you

Home Phone Number

Mobile Phone Number

Home Phone Number

Mobile Phone Number

Email (It is important that you provide us with an active email as you will be contacted by email)

Current School Attending as of Today

If your school is not listed please enter it here

Current Grade as of Today

Ethnicity

Caucasian

Hispanic or Latino

Black or African American

Native American or American Indian

Asian / Pacific Islander

Other, Mix, or Biracial

Gender

Parent/Guardian Contact Information

Relationship to Applicant

Cell/Work Phone (must be different from the applicant's)

Email (must be different from the applicant's)

Add a Secondary Parent/Guardian

Relationship to Applicant

Cell/Work Phone (must be different from the applicant's)

Email (must be different from the applicant's)

Work Experience and/or Community Service

Name of Organization

Title / Position

Type of Work

Describe your work duties

Start Date

End Date

Add More Work Experience

Name of Organization

Title Position

Type of Work

Describe your work duties

Start Date

End Date

School Activities and Sports

Club/Sport Name

Position

Explain your involvement in club/sport

Add Second School Activity or Sport

Club/Sport Name

Position

Explain your involvement in club/sport

Add Third School Activity or Sport

Club/Sport Name

Position

Explain your involvement in club/sport

References

Reference # 1 Name

Relationship to Applicant

Cell/Work Phone

Reference # 2 Name

Relationship to Applicant

Cell/Work Phone

Student Information

Parent/Guardian Contact Information

School Activities and Sports

References

By checking the following boxes, you confirm the following: