Youth Leadership & Employment Academy
RRHA RESIDENTS ONLY!
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Full Name *
WILL NEED TO HAVE ID CARD FOR PAPERWORK, CHECK AND CASHING- Email it to eliza.stokes@rrha.com
Address *
Phone *
Email *
Date of Birth (mm/dd/yy) *
Gender *
Are you bilingual? *
Parent/Guardian Name(s): *
Parent/Guardian Home Phone: *
Parent/Guardian Cell: *
Parent/ Guardian Email: *
Parent/ Guardian Email: *
Current School: *
Current Grade Level: *
Current Grade Point Average (GPA): *
REPORT CARD MUST BE SUBMITTED WITH APPLICATION - Email it to eliza.stokes@rrha.com
Do you require any special accommodations to perform placement duties? *
What Programs are you applying for?
*
Open Positions *
Required
Which session would you prefer? (Please select one) *
Previous Experience #1
Company *
Job Title *
Job Responsibilities: *
Length of Service *
Previous Experience #2
Company *
Job Title *
Job Responsibilities: *
Length of Service *
Interest
Please indicate any school/community activities you’ve participated in, in the last three years: *
Are you available to commit to 20 hours per week? *
Please highlight your top three areas of interest for work experience: *
Required
Shirt Size (Please select one) *
For more information, contact: Your Resident Services Coordinator
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