Co-op Connections Application
WHAT? A group of youth, ages 14-18, ready to learn about cooperative business, social and environmental justice.

WHEN? 21 hours / week in the summer 5-7 hours / week fall and spring

WHERE? Based at 4 King St, Worcester

WHO? A youth-led program of the Worcester Roots

To complete the application process, you need to attend an interview. We will contact you to schedule an interview.

Email: info@worcesterroots.org

submit form below or mail in or drop off completed application 4 King St, Worcester, MA 01610

Call 508-343-0035 with questions.

Full Name *
Your answer
Nickname
Your answer
Gender
Your answer
Date of Birth *
Your answer
School
Your answer
Grade *
Your answer
Name of Guardian/Parent *
Your answer
Address
Your answer
Home Phone Number
Your answer
Cell Phone *
Your answer
Parent’s Work Number
Your answer
Do you speak any languages besides English? If so, what language(s)? *
Your answer
Please tell us why you want to be a Toxic Soil Buster: *
Your answer
What is unique about you? Any special skills or talents? What would you bring to our group? *
Your answer
What is something you would change in your community? *
Your answer
How did you hear about this opportunity? *
Your answer
To be in Co-op Connections, you need to commit to coming to the program Monday-Thursday late June-August. Are you willing to make that commitment? *
What is your previous work, internship, or volunteer experience?
Your answer
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