[City of Sacramento] 2020 S@CH Application

Student Application

Applications Due Wednesday, April 22, 2020

A program collaborative between City of Sacramento's Department of Youth, Parks, & Community Enrichment - Youth Division, Natomas Unified School District, Sacramento City Unified School District & Twin Rivers Unified School District.

Student Information

Phone Number

Birthdate

Current School Attending

Please print your school name

Current Grade Level

I identify my ethnicity as: (Select all that apply)

Asian

Black or African

Caucasian

Hispanic or Latinx

Middle Eastern or North African

Native American

Pacific Islander or Filipino

Gender

Parent/Guardian Contact Information

Relationship to Applicant

Home/Cell/Work Phone

Email (Must be different from student's email)

Add a Secondary Parent/Guardian

Relationship to Applicant

Home/Cell/Work Phone

Email (Must be different from student's email)

Work Experience and/or Community Service

Name of Organization/Employer

Type of Work

Paid Full-Time

Paid Part-Time

Internship

Volunteer

Describe your work duties

Start Date

End Date

Add More Work Experience

Name of Organization/Employer

Type of Work

Paid Full-Time

Paid Part-Time

Intern

Volunteer

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