2019 Summer Youth Internship                 August 5, 2019-August 9, 2019
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Please enter your first name *
Please enter your last name *
What is your age? *
Most Recent Grade Completed *
What is your current telephone number?
What is your current email address? *
What days are you available to work with SSA? *
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Do you need assistance with Transportation? *
What form of transportation will you use to attend the program? *
What is the name of your DSS worker?
What is the contact number of your DSS Worker? *
What is the name if your Foster Parent (if applicable) ? *
What is the contact number of your Foster Parent? *
Why are you interested in participating in the SSA Internship Program? *
What do you hope to learn from this Internship experience? *
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