Girls Inc. of the Central Coast Smart Choices Program Application
Please complete the following information. Please note that there is a $360 fee for the Smart Choices Program. Click on the following link to submit your payment: https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=83QEAVQAN6M3A
Last Name:
Your answer
First Name:
Your answer
Middle Name:
Your answer
Mailing Address:
Your answer
Apartment Number:
Your answer
City:
Your answer
State:
Zip Code:
Your answer
Phone Number:
Your answer
Birthdate:
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YYYY
Mother's Full Name:
Your answer
Father's Full Name:
Your answer
Person to Contact in Case of Emergency:
Your answer
Relationship to Applicant:
Your answer
Emergency Contact Number:
Your answer
Ethnic Group:
(For statistical purposes only)
Race:
(For statistical purposes only)
Annual Household Income:
(For statistical purposes only)
Number of Family Members Living in Household:
Your answer
Family Type:
Primary Language Spoken at Home:
Middle School Attending:
Your answer
High School You Will Attend:
Your answer
Do you plan to go to college?
If yes please answer the next question.
Are you involved in any other summer program?
What program?
Your answer
Are you planning to attend summer school?
When do you start?
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