Page-JC Application — Summit Educational Association

Name

First Name

Last Name

Date of Birth

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

High School Attending

Expected Graduation Date - approximate

YYYY

Grade Point Average

Mother and Father's Name

First Name

Last Name

Mother or Father's Phone #

(###)

###

####

Emergency Contact

First Name

Last Name

Emergency Contact Phone

(###)

###

####

How Many Years Have You Been In Summit?

Mother or Father's Email

Favorite and Least Favorite Subjects and Why?

Hobbies, Interests, and Extra Curricular Activities?

SHORT ESSAY - Why Do You Want to Be a JC?

Thank you for your interest in being a Junior Counselor.

We will get back to you within one week. If we do not, please call 414-364-2902 to check the status of your application.