Community Development Apprenticeship Program Application 2016
Community Development Apprenticeship Program Universal Permission Form
(Effective Dates: January 1, 2016 — December 31, 2016)
How did you hear about this program?
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Participant Information
Please fill out all participant information below

PARTICIPANTS MUST BE A RESIDENT OF THE CITY OF NEWARK AND COMMIT TO ATTENDANCE FOR 6-WEEK SESSION

First Name *
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Last Name *
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Age *
Participant's E-mail
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Date of Birth *
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Grade *
Street Address *
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Zip Code *
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Parent/Guardian Information
Please fill out all Parent/Guardian information below

It takes a village to raise a child! We encourage ALL Parents & Guardians to support your child throughout the program in every way possible.

Name *
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E-mail *
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Please list all phone numbers where the parent/guardian can be reached *
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Please list all emergency contacts/relation *
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What interests you most about the program? *
Required
Is there anything else that you are hoping to gain out of the experience?
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