CYLAB Application
Get more details at www.njcylab.org or follow NJCLAB on Facebook or Instagram. Please complete this form. We will contact you with an interview date, time, and location. You must complete this form once you start it, or your information will be deleted and you'll have to start over.
FIRST NAME *
Your answer
LAST NAME *
Your answer
STREET ADDRESS *
Your answer
CITY, STATE, ZIP CODE *
Your answer
Phone number
Your answer
Parent *
Add the name of the parent/guardian that will be responsible for you participating in the program.
Your answer
Parent/Guardian phone number *
Your answer
What neighborhood do you live in? *
What high school do you attend? *
Your answer
What grade are you in? *
Are you available to attend the orientation on September 18th? *
Are you available to attend program September – December three days a week 5-7:30pm? *
Do you have reliable transportation to get the site? *
Have you read the details about the CYLAB and how it is connected with youth court? *
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