Survey Questions for SummerWorks 2016 On Line Registration
Please fill in the fields below, making sure to enter your first and last name and date of birth so that you do not accidently create two records.
I will be 16 to 21 years old on June 1st 2016?:*
Birth Date:* / /
Last Name:*
First Name:*
Primary Phone:* - -
Texting Phone:* - -
Zip Code:*
Confirm Email:*
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.*
Are you currently enrolled in 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?*
Please click Submit only ONE time. You will receive an automatic confirmation email in a few moments.