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Student Application
Youth Business Mentoring Program
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* Indicates required question
Please fill out all of the information below. If something does NOT apply, please put N/A (not applicable).
YOU need to complete it, no one else.
Today's Date
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First Name
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Your answer
Middle Initial
Your answer
Last Name
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Your answer
Street Address
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Your answer
City
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Your answer
Zip Code
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Your answer
Date of Birth
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Age
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Your answer
Sex assigned at birth
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Please indicate your sex assigned at birth.
Female
Male
Other:
Gender Identity
Please identify your gender identity, if different than your sex assigned at birth.
Your answer
Please indicate your preferred pronouns
For example: she/her/hers, they/them/theirs, he/him/his, etc.
Your answer
School
*
Your answer
School Grade
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8th
9th
10th
11th
12th
What is your school office (neighborhood)?
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Your answer
Race/Self Identification
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Check all that apply
American Indian or Alaska Native
Asian
Black or African-American
Hispanic or Latinx
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White or Caucasian
Required
Besides English, do you speak any other languages fluently?
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Yes
No
If yes, which one(s)?
Your answer
Do you have any special needs or need accommodations in order to be successful in our program or at a job?
Yes
No
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If yes, please explain.
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