Youth Excel Application — Midwest City Chamber of Commerce

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Youth Excel Application

All applications must be received by September 14, 2021 and be accompanied with a release waiver.

PERSONAL INFORMATION

Questions marked with an asterisk (*) are required.

Student Name *

First Name

Last Name

Name you preferred to be called

Email *

Home Phone

(###)

###

####

Cell Phone *

(###)

###

####

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian's Name *

First Name

Last Name

Parent's relationship to you *

Parent/Guardian's Place of Employment *

Parent's Phone *

(###)

###

####

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Describe up to three activities or accomplishments that have made you proud of yourself: *

ACTIVITIES

List up to five school, volunteer, religious, social, athletic or other activities or organizations in which you have participated during the last four years.

Organization/Activity #1

Name of Organization or Activity: *

Grade in School: *

Involvement: *

Organization/Activity #2

Name of Organization or Activity:

Grade in School:

Involvement:

Organization/Activity #3

Name of Organization or Activity:

Grade in School:

Involvement:

Organization/Activity #4

Name of Organization or Activity:

Grade in School:

Involvement:

Organization/Activity #5

Name of Organization or Activity:

Grade in School:

Involvement:

WORK EXPERIENCE

List any job experiences (paid or volunteer) and briefly tell length of time and what was involved: *

Do you currently have a job? *

Yes

No

How many hours per week do you work?

GENERAL INFORMATION:

Using a few phrases or adjectives, describe yourself: *

Please explain what you hope to gain by participating in Youth Excel: *

GPA *

(Selection to Youth Excel is not contingent upon your current grade point average.)

Shirt Size *

Adult Sizes

Small

Medium

Large

X-Large

XX-Large

XXX-Large

Which high school do you attend? *

Carl Albert HS

Midwest City HS

Please list the top three careers you have an interest in after high school: *

Do you have any food allergies or special dietary needs?

MENTORSHIP:

Each student participating in Youth Excel will spend half of a day during the weeks of October 11-29, 2021, in a job shadowing experience with a community business person. Date chosen by student and mentor.

PROGRAM DATES:

Tuesday, October 5, 2021 from 5:30 p.m. – 8:00 p.m. (Orientation) Tuesday, November 2, 2021 from 8:15a.m. – 3:30 p.m. Wednesday, November 3, 2021 from 8:15 a.m. –3:30 p.m.

ATTENDANCE:

One hundred percent attendance is required of each participant. To make sure you do not have unavoidable conflicts, please compare your schedule with ALL dates before completing the application.

I have read and understand the attendance requirement for Midwest City Chamber’s Youth Excel program. If selected, I agree to attend all sessions of the program. *

I agree

Retype your full name to serve as digital signature. *

Today's Date *

MM

DD

YYYY

RELEASE FROM LIABILITY AND AGREEMENT INDEMNITY

Please complete our release waiver (linked below) and return via email to information@midwestcityok.com for your application to be considered and/or accepted.

Thank you!

SPECIAL THANKS TO OUR EAGLE PARTNER:

CORPORATE MEMBERS:

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