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Form Section 1

Thousand Strong 2018-2019 Application

If you require accommodations to fill out and submit this, please reach out to

Application Deadline: April 8, 2018

Contact Info

Full Name *
Full Address *
Best way to contact you *
Accept Text Messages? (standard data and sms rates may apply) *

School Information

After Graduation I plan on attending... *

Parent/Guardian Information

Primary Parent/Guardian Name *
Additional Parent or Guardian? *
Secondary Parent/Guardian Name

Tell us about yourself

Do you have a mentor? A mentor is usually an adult other than your parents or guardians who provides advice or helps you out in some way. They might be part of an after school program, community organization, a church, mosque or temple, or a place you volunteer. *
Mentor Name *

Demographic Data

Are you or your family currently receiving any benefits from the following programs: Check all that apply (not required)

What is your date of birth? *
Date Picker

(click on month/year to change larger units of time in date picker)

Race or Ethnicity *
What do you identify as? *

Terms & Conditions

Terms & Conditions (must check all) *

Pledge: I can commit to a year-long internship and will not have conflicting school or extracurricular activities starting in June and potentially ending the following year in June 30, 2019.

By placing your name below you acknowledge the year-long commitment required to be part of the Thousand Strong.

Please type your full name below. 

Full Name *