Youth Plan - Huntington Park
ALL THE INFORMATION PROVIDED IN THIS APPLICATION IS CONFIDENTIAL AND WILL BE USED SOLELY FOR THE PURPOSE OF YOUR REGISTRATION WITH THE YPHP ACADEMY.

MUST BE RETURNED TO THE MAIN OFFICE BY MARCH 11, 2016

After you complete the application Please Submit One letter of reference from a teacher, counselor, administrator, or other non-related adult that can speak to your strengths and commitment commitment. The recommendation form can be found here.

First Name *
Your answer
Last Name *
Your answer
Middle Initial *
Your answer
Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Birth date *
MM
/
DD
/
YYYY
Age *
Your answer
Main Phone Number *
Your answer
Alternate Phone Number *
Your answer
Current Grade Level *
Name of School *
Your answer
What change do you hope to see in your community? (MAX 500 words) *
Your answer
By submitting this application you acknowledge the following:
I have gotten verbal permission from my parents or guardians to apply to this program. This is mandatory in order for your application to be accepted.

I understand that the YPHP Academy will take place from 9:00 AM to 1:00 PM on the following Saturdays: 3/19/16, 4/2/16, 4/16/16, 4/30/16, 5/14/16, and 5/28/16.

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