JVS Student Application

Student:

Address:

Birth Date:

Sex: Female Male

School:

Phone

Email:

Residency:

Mother/Guardian's Name:

Work/Cell Phone Number:

Email:

Father/Guardian's Name:

Work/Cell Phone Number:

Email:

First Program: Visited: Yes No

Second Program: Visited: Yes No

Please check all that apply to the applicant:

Participated in a JVS career fair as a 6th grader

Participated in a JVS tour as an 8th or 9th grader

Attended a JVS ExCEL Summer Career Camp

Attended a JVS Open House

New Application