I will be 16 to 21 years old on June 1st 2016?:*

Birth Date:*

First Name:*

Last Name:*

Primary Phone:*

Texting Phone:*

Address:*

Zip Code:*

Email:*

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Communication Preference:* (check box – can select more than one)

Are you a participant in any of the following programs? If you’ve participated in more than one program on the list, select the "one" most recent or the "one" where you are most active.*

- Select - Baxter Community Center Beechmont Community Center California Community Center Cyril Allgeier Community Center Douglass Community Center Newburg Community Center Parkhill Community Center Portland Community Center Shelby Park Community Center South Louisville Community Center Southwick Community Center Sun Valley Community Center Americana Community Center Bates Community Center Canaan Community Center Louisville Central Community Center Presbyterian Community Center

Are you currently enrolled in school?:*

- Select - Academy for Individual Excellence Assumption High School Atherton High School Ballard High School Beth Haven Christian School Central High School Christian Academy Covenant Classical De Sales High School Doss High School DuPont Manual High School Eastern High School Evangel Christian School Fairdale High School Fern Creek High School Highlands Latin School Holy Cross High School Iroquois High School Jeffersontown High School Kentucky Country Day School Landmark Christian Academy Liberty High School Louisville Adventist Academy Louisville Classical Academy Louisville Collegiate Academy Louisville Male High School Mercy Academy Moore High School Northside Christian School Olmstead Academy North Olmstead Academy South Pleasure Ridge Park High School Portland Christian School Presentation Academy Sacred Hearth Academy Seneca High School Shawnee High School South Park TAPP Southern High School St. James Academy St. Xavier Academy Trinity High School Valiant Christian Academy Valley High School Valor Traditional Academy Victory Christian Academy Waggener High School Walden School Corporation Western High School Whitefield Academy Other High School

What is your degree status?:*

Have you ever had a job before?:*

Have you ever held the same job for longer than 3 months?:*

Do you have a resume?:*

Are you currently employed?:*

When you get a job, how will you get to work?*

How did you hear about the program?*

What location are you registering from?*

What do you hope to gain from participating in the Mayor's SummerWorks Program?*

If you have one, Please provide us a copy of your resume.

Please click Submit only ONE time. You will receive an automatic confirmation email in a few moments.