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Springboard Initiative Application
The Springboard Initiative High-Tech Workforce Program Application (Deadline: June 30, 2016)
Applicant Information
First Name:
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Last Name:
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Email address:
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Home Phone Number:
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Cell Phone Number:
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Date of Birth:
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Current Age:
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Ethnicity:
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Street Address:
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City/ State:
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Zip Code:
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Are you currently employed?
Parent/Guardian's Name:
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Parent/Guardian's Email Address:
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Parent/Guardian's Phone Number:
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How did you hear about the Springboard Initiative?
If other, please specify:
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Education
Currently enrolled in:
Last high school attended:
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Date of high school graduation:
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Name of college attending:
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College Major:
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Estimate date of college graduation:
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Are you a first generation college student?
Are you currently employed?
Do you currently own (or have a) computer?
Experience
HTML
C#
C++
Visual Basic
Microsoft Office
Javascript
Ruby on Rails
Networking
Leadership
Cultural Competency
Recommendations/Consent/Release
Please share the name of at least one educator or administrator that you've known for at least a year. Please ask them to complete a letter of recommendation and nomination form. We will email the necessary form to the address provided below and they can email the recommendation to info@momagic.org.
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Name:
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Email:
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I certify that my answers are true and complete to the best of my knowledge. I understand that this information may be shared with several organizations including but not limited to Springboard, Base 11, Mo'MAGIC, Ellie Mae and the Bayview YMCA. I understand false or misleading information in my application or interview may result in my disqualification.
Signature (if under 18, parent or guardian must sign):
Your answer
Please initial and sign below
I irrevocably authorize the Springboard Initiative, it's employees, partners and its agents, to use my name, picture, likeness and words for any purpose that the Springboard deems appropriate - including promotional or advertising efforts. (Initial_____)
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I also specifically authorize Springboard, its employees, partners and agents to use, reproduce, exhibit, or distribute my name, picture, words and likeness for such purposes in any communications medium currently existing or later created, including without limitation - print media, television and the internet. (Initial_____)
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I agree with and understand the statements above.
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Signature (if under 18, parent or guardian must sign):
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Essay Questions
Please submit responses to the questions below and attach them to your completed application.
In 500 words or less answer the question: What is your "PASSION" and how does your passion connect with technology?
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Share in 750 words or less information that will help us determine if you are well-suited for selection to the Springboard Initiative Training Program.
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Household Income
What is your household income (includes you and parents/ guardians)?
Does anyone in your household receive financial aid or federal assistance? If yes, please explain below.
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