Jóvenes en Acción Application If you are having issues submitting this application, please email info@hydesquare.org or call 617-524-8303.JEA will be virtual for the spring of 2021. If you were to rank your preferred art discipline, which would be your first choice?* DANCE MUSIC THEATRE If you were to rank your preferred art discipline, which would be your second choice?* DANCE MUSIC THEATRE If you were to rank your preferred art discipline, which would be your third choice?* DANCE MUSIC THEATRE How did you find out about our program?*Music Clubhouse (MCH)Dance/Theatre at HenniganSocial MediaSchool PresentationFlyerSchool Field Trip to HSTFTeacherFriendOpportunity FairViva EventOtherHSTF Community EventDance/Theatre at Margarita Muniz AcademyOther:Participant InformationName:* First Last Date of Birth:* MM DD YYYY Age*Gender:* Female Male Non-Binary Gender Questioning Gender Transitioning Other If other, please specify:*Address:* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone Number:*Cell Phone Number:*Email Address:* Which of the following best describes you? Please choose one answer:* Asian or Pacific Islander Black or African American Hispanic or Latino Native American or Alaskan Native White or Caucasian Multiracial or biracial A race/ethnicity not listed here If other, please specify:*Country of Origin*BrazilCape VerdeColombiaCosta RicaCubaDominican RepublicEcuadorEl SalvadorGuatemalaHaitiHondurasJamaicaMexicoOtherPanamaPeruPuerto RicoUnited States of AmericaVenezuelaWhat school do you currently attend?* Academy of the Pacific Rim Boston Arts Academy Boston Collegiate Boston Community Leadership Academy Boston Green Academy Boston International School Boston Latin Academy Boston Latin School Boston Preparatory Boston Teacher's Union K-8 School Brighton High Brooke 8th Grade Academy Brooke High Burke High Charlestown High City on a Hill (Dudley) City on a Hill Codman Academy Conservatory Lab Curley K-8 Dearborn STEM Academy East Boston High Edison K-8 English High Excel Academy Excel High Fenway High Henderson K-12 Inclusion Hennigan K-8 Irving Middle Kennedy Academy for Health Careers 11-12 Kennedy Academy for Health Careers 9-10 Madison Park Margarita Muniz Academy MATCH Middle MATCH High McCormack Middle Mission Hill K-8 Murphy K-8 New Mission High Newcomers Academy O'Bryant Quincy Upper School Roxbury Preparatory Snowden International School at Copley TechBoston Academy Timilty, James P. Middle Tobin K-8 UP Academy Dorchester Urban Science Academy Young Achievers Science & Math K-8 Other If you selected "other" above, please write in the name of your school below.What grade are you in?9th10th11th12th8thParent / Guardian InformationParent / Guardian Name:* First and Last Relationship to Youth:*Address*Street City, State, ZIP CodeHome Phone Number:*Cell Phone Number:*Email Address:* Parent/Guardian Country of Origin*BrazilCape VerdeColombiaCosta RicaCubaDominican RepublicEcuadorEl SalvadorGuatemalaHaitiHondurasJamaicaMexicoOtherPanamaPeruPuerto RicoUnited States of AmericaVenezuelaConsent You have my consent.The information provided on this form is true and accurate to the best of my knowledge and I give permission for my son/daughter to participate in Hyde Square Task Force programs and activities.Parent / Guardian Signature:*Participant Signature:*Date:* Date Format: MM slash DD slash YYYY
