Teen Institute Application 2021
For more information call/text K.C. Missall at 262-221-5552 or kmissall@focusracine.org

Applications are due June 14th.
Name of Applicant *
Gender *
What school will you go to next school year? *
Grade you'll be in the Fall *
Applicant Cell Phone Number *
Applicant Email Address *
Why should we select you to attend the Teen Institute retreat? *
What would you like to get out of the Teen Institute retreat? *
Describe the qualities that make you a good role model or leader. *
What do you think are the major problems young people in Racine County face? *
By signing this form I agree to abide by all the rules of Teen Institute and to fully participate in all activities. I agree to listen to and cooperate with Focus Staff at all times. I understand that no alcohol, tobacco or other drug use will be allowed at any time during the retreat. Please type your full name and date down below: *
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