Application: Purpose Pays

Purpose Pays Program Participant Application

This application must be filled out in its entirety by the student only.

You must be enrolled in an EJS Project program.

You must be age 15-18 during the entire program.

Student Information

Student First Name

Student Last Name

Date of Birth

Cellphone Number

Shirt Size

About You

How long have you lived in Delray Beach prior to the date of this application?

Have you previously worked for the Purpose Pays Program?

At school, I am most interested in these subjects or activities:

Outside of school, I enjoy these activities:

At home, I can be counted on to do a good job at:

I feel proud of myself when I:

Parent Information

Parent First Name

Parent Last Name

Parent Phone

Address

City

State

Zip

Emergency Contact

In case of emergency, please notify:

Full Name

Relationship

Address

City

State

Zip

I certify that I have answered all of the above questions, and all statements are true. I understand that any misrepresentations or omissions may cause my application to be rejected, or forfeit my right to be considered for employment with the Purpose Pays Program. I understand that selection preference will be given to ‘first time’ participants.