Teen Application for Summer Program

This summer, Columbia County Community Connections, in cooperation with area businesses, will host a summer camp for teenagers 14-19 that will provide work experience, classes in work-related areas such as work ethics, appropriate work behavior, customer service skills, dressing for success, budgeting for the future, living healthy, and weekly field trips.

Twenty students who meet the financial eligibility criteria, satisfactorily complete the summer camp application and have a successful interview will be accepted into the program. Students who participate in the program and follow the rules will receive a stipend equivalent to a minimum wage salary of 35 hours per week.

Camp will be held for 5 weeks this summer. The dates are June 30 – July 31. Camp will held Monday through Thursday from 8:30 a.m. to 4 p.m. Transportation will be provided if needed.

If you are interested, please fill out the application and turn in by the deadline. The deadline for this application is Friday, June 6, 2008 at 4 p.m. No exceptions. Applications may be mailed, faxed or delivered in person. Our mailing address is P.O. Box 99, Harlem, GA 30814. We are located in the City of Harlem Administrative Office at 110-B North Louisville Street, Harlem. Our fax number is 706-556-0609.

Students whose applications are complete and meet the requirements will be called during the week of June 9 through June 13 to set up an interview. Interviews will be held June 16-18. A panel of impartial judges will determine who is selected for camp. Applicants will be notified Friday, June 20, if they are accepted. If an applicant has not heard from us by 5 p.m. on June 20, then that applicant was not selected. All decisions made by the judges will be final and not subject to appeal.

Please do not apply if you can’t be there for the entire camp. Only two absences are allowed for any reason.

If you are selected for camp, you will be asked to sign an employment contract. If you are under the age of 18, we will also need your parent or guardian signature.

For more information, you may contact Julie Miller/ Director or Teka Allen/ Assistant Director at 706-556-0609.

Contact Information

Name
Birthdate/Year
High School Grade
Street Address
City State ZIP Code
Home Phone
Cell Phone
E-Mail Address
Parents/Guardian Name and Contact Information

Special Skills or Qualifications

List special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports.

Summary

Write 3 complete sentences on why you want to participate in camp.

Person to Notify in Case of Emergency

Name
Street Address
City ST ZIP Code
Home Phone
Work Phone
E-Mail Address

Financial Eligibility

Do you qualify for free or reduced lunch? _____ Yes _____ No

Do you receive Social Security, disability, TANF, or food stamps? _____ Yes _____ No

Are you enrolled in the PeachCare program? _____ Yes _____ No

Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if my answer is yes to any of these questions, my teen meets the financial qualifications for the summer apprenticeship program.

Student Name (printed)
Signature
Parent/ Guardian (printed)
Signature
Date

Financial Eligibility … continued

If your answer is no to all the above questions, your teen may still meet the financial eligibility requirements. Please see the next page for those guidelines.

Our Policy

It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

Thank you for completing this application form and for your interest in Harlem Summer Work Experience Program.

Contact Information

Special Skills or Qualifications

Summary

Person to Notify in Case of Emergency

Financial Eligibility

Agreement and Signature

Financial Eligibility … continued

Our Policy