Jóvenes en Acción Application If you are having issues submitting this application, please email recruiting@hydesquare.org or call 617-524-8303.What session are you applying for?* Summer (July - August) Fall (September - December) Winter (January - March) Spring (March - June) 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?*Artes Culturales: formerly Music Clubhouse (MCH)Current or Former Participant of HSTFFamily MemberFlyerFriendHSTF Community EventOpportunity FairSocial MediaSchool PresentationSchool Field Trip to HSTFTeacherOtherIf you selected "Other, Family Member, Friend, or Teacher" above please specify:* Why are you interested in joining our Jóvenes en Acción program?*Participant InformationName:* First Last Date of Birth:* Month Day Year Age* Gender:* Female Male Non-Binary Gender Questioning Gender Transitioning Other If other, please specify:* Address:* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Home Phone Number:*Youth Cell Phone Number (if available):*Youth 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 you selected "Multiracial or Biracial or race/ethnicity not listed here", please specify:* Country of Birth*BrazilCape VerdeColombiaCosta RicaCubaDominican RepublicEcuadorEl SalvadorGuatemalaHaitiHondurasJamaicaMexicoOtherPanamaPeruPuerto RicoUnited States of AmericaVenezuelaIf you selected "other" above, please write in the name of the country below.* What school do you currently attend?Academy of the Pacific RimAnother Course to CollegeBoston Adult Technical AcademyBoston Arts AcademyBoston CollegiateBoston Community Leadership AcademyBoston Day & Evening AcademyBoston Green AcademyBoston International SchoolBoston Latin AcademyBoston Latin SchoolBoston PreparatoryBoston Teachers Union K-8 SchoolBoston Trinity AcademyBrighton HighBrooke 8th Grade AcademyBrooke HighBurke HighCharlestown High SchoolCity on a HillCity on a Hill (Dudley)Codman AcademyCommunity Academy of Science & HealthConservatory LabCristo Rey BostonCurley K-8Dearborn STEM AcademyEast Boston HighEdison K-8Edward M. Kennedy Academy for Health CareersEnglish HighEnglish High SchoolExcel AcademyExcel HighFenway HighGreater Egleston High SchoolHenderson K-12 InclusionHennigan K-8Hernandez K-8Irving MiddleJoseph LeeKennedy Academy for Health Careers 11-12Kennedy Academy for Health Careers 9-10Madison ParkMarbleheadMargarita Muniz AcademyMATCH HighMATCH MiddleMcCormack MiddleMelvin King South End AcademyMeridian AcademyMETCO OtherMission Hill K-8Murphy K-8Newcomers AcademyNew Mission HighO'BryantOtherQuincy Upper SchoolRoxbury PreparatorySharonSnowden InternationalTecca Online SchoolTechBoston AcademyTobin K-8UP Academy DorchesterYoung Achievers Science & Math K-8If you selected "other or METCO" 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 Birth*BrazilCape VerdeColombiaCosta RicaCubaDominican RepublicEcuadorEl SalvadorGuatemalaHaitiHondurasJamaicaMexicoOtherPanamaPeruPuerto RicoUnited States of AmericaVenezuelaIf you selected "other" above, please write in the name of the country below.* Consent*The information provided on this form is true and accurate to the best of my knowledge and I give permission for my child to participate in Hyde Square Task Force programs and activities. You have my consent.Parent / Guardian Signature:* Participant Signature:* Date:* MM slash DD slash YYYY Δ
