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Youth CAUSE Initiative Intern and Volunteer Planning Form
Please complete the online "Youth CAUSE Initiative form" below. NO PAPER COPIES WILL BE ACCEPTED. For questions please contact Dr. Rob at
rob@youngscientistacademy.org
.
Participant Details
*
Indicates required field
Youth CAUSE Initiative Participant Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Date of Birth
*
MM/DD/YYYY
I identify my gender as:
*
Male
Female
Genderqueer/Non-Binary
I'd prefer not to disclose
Participant Phone Number
*
What school will you attend in Fall 2021?
*
What grade will you be in Fall 2021?
*
I accept my participation in the Youth CAUSE Initiative as a/an:
*
Voyage Youth Employment Program Participant
Volunteer
Parent/Legal Guardian Details
Please complete this section if participant is 18 years of age or younger.
Parent/Legal Guardian Name #1
*
First
Last
[object Object]
Parent/Legal Guardian Name #2 (Optional)
*
First
Last
[object Object]
Best Parent Phone Number
*
Parent Email #1
*
Parent Email #2
*
Schedules & Personal Expectations
I am available to work the following shifts on Tues-Fri:
*
Morning - 8a-12.30p
Afternoon - 12p-4p
Evening - 3p-7p
Can you work Saturday shifts?
*
Yes
No
Please list any people you would like to work with each shift?
*
What are your goals for the summer? What things would you like to learn?
*
Which of the following field adventures would you like to attend?
*
NC Museum of Art & NC State Tour (possibly Epic Games)
Lake Waccamaw Weather Balloon Launch
Fort Fisher & Carolina Beach State Park
Bald Head Island Conservancy Sea Turtle Trip
None
Skills and Attributes
Have you taken any science classes at school?
*
Yes
No
If yes, what science topics?
*
Which of the following science themes are you familiar with?
*
Climate Change
Urban Sustainability
Public Health
Which research projects would you like to be a part of this summer (can select as many as you like):
*
Mission Sol Weather Balloon Climate project
Jellyfish Climate Experiments
Cape Fear Heat Map Project
Wilmington Greenspace & Storm Drain Flooding Project
Python Coding & Website Development
Marketing and Branding
Vaccination Strategies & Public Health Issues for NHC
Food deserts & Nutrition
Water Quality & GenX Monitoring
Are you currently CPR certified?
*
Yes
Previously certified but it has expired
No but I would like to be certified
Do you speak any Spanish?
*
Yes
No
What skills do you have that you could employ this summer?
*
Do you like to do any of the following
*
Digital film
Social media
Cooking
Artwork
Coding
Gaming
Debate & Discussion
Reading & Writing
Listening to Music
Play sports
Build things/construction
Photography
Do you have any favorite food items or recipes?
*
What social media platforms do you use?
*
Submit
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About
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Contact
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