APPLICATION

Saving Innocent Children Incorporated

Girls Mentorship Summer Program

Application
*request an application by emailing sicincceo@gmail.com*

Name: ____________________________

Age:__________

Number:________-________-________

Email Address:______________________

Mailing Address:_____________________
Current High School:__________________


Reason you wish to join S.I.C. Inc:
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Weekly Availability: (please list times that you are available)

MON: ____________________

TUES:_____________________

WEDS:____________________

THURS:____________________

FRI:_______________________

SAT:______________________
SUN:______________________


EMERGENCY CONTACT

Name:_______________________

Relation to Applicant:________________

Number:__________________________

Type (circle one): Home Cell Work Other



HOLISTIC

Talent (circle all that apply):

Singing                  Acting                            Dancing



Modeling          Design (Fashion)            Design (Web/Flyer)



Directing           Art (Drawing)                 Art (Painting)



Art (Digital)             Writing                        Film



Cosmetology (hair)       Cosmetology (make-up)            Producing (Music)


Instrumentalist Composer Other:__________________


ACADEMIC

Which subject are you best at:______________________
Which subject are you worse at:_____________________

Are you bilingual? YES or NO
Would you like to learn another language? YES or NO

(If so, please specify the language)____________________



LEADERSHIP

In your own words, what does it mean to be an outstanding leader?

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CULTURAL:

What is your ethnicity (optional): ________________________
Who influences you in a positive way:_____________________

Who influences you in a negative way:____________________

What is your best personality trait:_______________________

What is your worse personality trait:_____________________

Do you feel that your “skin color” effects your success as an American student?

YES or NO



If Yes, please explain:_____________________
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If No, please explain::____________________
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PARENTAL CONSENT

Parents Name:_______________________

Parents Signature:_____________________

Applicants Name:_____________________

Applicants Signature:__________________

Date: ________________