B-SAFE 2017 JCIT Application
Name *
Last, first, Middle Initial
Your answer
Street Address *
Include Apt. Number
Your answer
City, State, Zip *
Your answer
Best Phone *
Your answer
E-Mail *
Your answer
School Attending *
Your answer
Grade *
Your answer
Are you between the ages of 13 and 15? *
Your answer
How did you hear about us? -If from friends or family, please name them.
Your answer
Why do you want to be part of the JCIT program? (List at least 3 reasons) *
Your answer
What do you want to teach younger kids? *
Your answer
What skills/talents/interests do you have to offer the program? *
Your answer
What do you want to learn from being part of the JCIT program? What are some of your challenges, learning edges, weaknesses in working with younger kids? *
Your answer
Have you ever done community service? What was it? Was it fun? Would you be willing to do it again? *
Your answer
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