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URECA YLC Application: Personal Information
Email address *
First Name: *
Last Name: *
Please upload your 2018-19 school picture: *
Required
Upload your favorite selfie or picture of you: (please make sure you can be easily identified and that the picture is appropriate for all audiences)
gender: *
date of birth: *
MM
/
DD
/
YYYY
mobile number: *
mailing address: *
high school: *
Are you a Junior this year (2018-19)? *
What is your GPA? *
Do you live in a home that receives its power from SESD? *
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