[City of Sacramento] 2023 S@CH Application

Application Due Friday, April 21, 2023A program collaborative between the City of Sacramento Department of Youth, Parks, & Community Enrichment - Youth Division, Natomas Unified School District, Sacramento City Unified School District & Twin Rivers Unified School District.

Name

First Name

Last Name

Address

Street Address

City

State

Zip

Phone/Cell Phone Number

Email [It is important that you provide us with an active email as you will be contacted by email.]

School District Name

Current School Attending

I identify my ethnicity as

I identify my gender as

Parent/Guardian Information

Primary Parent/Guardian Name

First Name

Last Name

Relationship to Applicant

Email (Must be different from student’s email.)

Secondary Parent/Guardian Name

First Name

Last Name

Relationship to Applicant

Email (Must be different from student’s email.)

Work/Volunteer Experience and/or Community Service

Name of Organization/Employer or Supervisor

Describe your duties

Name of Organization/Employer or Supervisor

Describe your duties

School Activities, Athletics, or Extra-curricular Activities

Club/Sports/Activity Name

Explain your involvement in the club/sport/activity

Club/Sports/Activity Name

Explain your involvement in the club/sport/activity

Reference #1 Name

First Name

Last Name

Relationship to Applicant

Reference #2 Name

First Name

Last Name

Relationship to Applicant

Please Answer the Following Questions

Why are you a good participant candidate for the 2023 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.) Have you thought about a solution for this problem?

Tell us about a challenge or conflict you have faced, and how you were able to overcome it.

I understand that there will be an 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 3, 2023.

If selected, I commit to attending the program in its entirety, including orientation, the full six week of programming, afternoon internship/workshops, presenting to the City Council, and attending graduation.

If selected, I understand that classroom instruction is Monday thru Friday, 8:30 AM–12:00 PM.

If selected, I understand that in addition to the classroom instructional hours I am required to complete 42-hours of an internship & Life Skills Workshop series.

Signature

First Name

Last Name

Choose how to sign

Draw Type

By signing below, I certify that all information in my application is true, complete, and correct.

Student Information

Parent/Guardian Information

Work/Volunteer Experience and/or Community Service

School Activities, Athletics, or Extra-curricular Activities

References

Please Answer the Following Questions