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2022 S@CH Application
Student Information
Full Name
First Name
Last Name
Full Address
Street Address
City
State
Zip
Email
Phone Number
Current School Attending
Choose One
American Legion
Arthur A. Benjamin Health Professions
CK McClatchy
Creative Connections Arts Academy
Discovery
Foothill
George Washington Carver
Grant Union
Highlands
Hiram Johnson
Inderkum
John F. Kennedy
Keema
Kit Carson International Academy
Leroy Greene Academy
Luther Burbank
Natomas
Natomas Charter
Natomas Pacific Pathway Prep
Pacific
Rio Linda
Rosemont
Sacramento Accelerated Academy
Sacramento Charter
Sacramento New Technology
School of Engineering & Sciences
The Met Sacramento
Vista Nueva
West Campus
Other
Current School Attending Other
Current Grade Level
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Sophomore
Junior
I identify my ethnicity as
Choose One
Asian
Alaska Native
Black or African American
Caucasian
Hispanic or Latinx
Middle Eastern or North African
Native American
Native Hawaiian, Polynesian, Pacific Islander or Filipino
Self-description
Prefer not to answer
I identify my ethnicity as self-description
Parent/Guardian Contact Information
Primary Parent/Guardian Name
Relationship to Applicant
Home/Cell/Work Phone
Email (Must be different from student's email)
Second Parent/Guardian Name
Relationship to Applicant
Home/Cell/Work Phone
Email (Must be different from student's email)
Work/Volunteer Experience and /or Community Service
Name of Organization/Employer
Type of work
Choose One
Paid full-time
Paid part-time
Paid internship
Volunteer/internship
Describe your duties
Start Date
End Date
Name of Organization/Employer
Type of Work
Choose One
Paid full-time
Paid part-time
Paid internship
Volunteer/internship
Describe your duties
Start Date
End Date
School Activities & Athletics
Club/Sports Name
Position
Explain your involvement in the club/sport
Club/Sports Name
Position
Explain your involvement in the club/sport
References
Reference #1 Name
Relationship to Applicant
Cell/Work Phone
Email
Reference #2 Name
Relationship to Applicant
Cell/Work Phone
Email
Please Answer the Following Questions
I am interested in being part of the program
VIRTUALLY (activities are through ZOOM or Google classroom)
IN-PERSON (instruction/internship held at a physical location – City Hall or offsite location)
No Preference
Why are you a good candidate for the 2022 Summer @ City Hall program?
Tell us about a local issue or problem in your community that you are concerned about. (Examples: homelessness, education, violence, housing, access to technology, jobs, food access, etc.)
Tell us about a challenge or conflict you have faced, and how you were able to overcome it.
I understand that there will be a virtual interview that I am required to attend as part of the selection process.
If selected, I understand that I will be required to attend a mandatory Student & Parent/Guardian Orientation on Saturday, June 4, 2022.
If selected, I understand that I will be required to attend a workshop on Friday, June 17, 2022.
If selected, I understand that the program is Monday – Friday from June 20 – August 1st, 2022, and I am willing to commit to the full six-weeks of the instructional/internship/workshop programming including graduation (July 25), City Council meeting (July 26), & Sacramento Youth Commission meeting (August 1).
If selected, I understand that classroom instruction is Monday thru Friday, 8:45 AM–12:00 PM.
If selected, I understand that in addition to the virtual classroom instructional hours I am required to complete 42-hours of an internship & Life Skills Workshop series. The workshop series sessions are held in the weekday afternoons between 12:30pm and 4:30pm. A schedule of sessions will be provided.
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