2010 Summer Apprenticeship Program

Contact Info

Name: *

Address: *

City: *

State: *

Zip: *

Phone: *

Email: *

Optional Identity Questions

This information is for recording purposes only. It does not affect acceptance of your application in any way.

If 'other':

Program Application

Have you done video production work with other programs or at school? List those programs, jobs, and classes here: *

Are you able to attend all program dates: Tuesdays and Thursdays July 14 - August 27, 10:00 AM - 4:00 PM?: *

Have you participated in Reel Grrls programs in the past? Please list programs here: *

Please write a one-page letter expressing your interest in this program, and why Reel Grrls should hire you for this job. Make sure to include your relevant video production and interpersonal skills.: *

Attachment (if any):

Upload a file to accompany your application.

Confidential Medical and Emergency Information

This information does not affect the acceptance of your application in any way. It purely enables Reel Grrls to create a safe and healthy environment for you as an apprentice, should your application be accepted.

Parent/Guardian Name1: *

Parent/guardian email1:

Parent/guardian phone (home)1:

Parent/guardian phone (work)1:

Parent/guardian phone (cell)1:

Parent/guardian name2:

Parent/guardian email2:

Parent/guardian phone (home)2:

Parent/guardian phone (work)2:

Parent/guardian phone (cell)2:

Teen lives with :

Mother

Father

Guardian

Other

If other:

Emergency Contact Name: *

Emergency Contact Relationship: *

Emergency Contact Phone: *

Medical History

Do you have any physical complaints or chronic illness at this time?: *

YES

Have you had injuries in the past (i.e., back, knee, etc.)? : *

YES

Are you currently taking medications of any kind?: *

YES

Dietary Needs:

I am a vegetarian

I don't eat dairy products

I have other dietary needs

Any additional information (diet or medical information)?:

Friend me on:

Facebook and my username is:

MySpace and my username is:

Twitter and my username is:

Flickr and my username is:

YouTube and my username is:

Lucia

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2010 Summer Apprenticeship Program