Jóvenes en Acción Application
Thank you for your interest in Jóvenes en Acción!
Instructions: All fields marked “required” must be completed. Dates should all be typed in the format mm/dd/yyyy.
Program Information
First Name
Last Name
What session are you applying for?
Summer (July - August)
Fall (September - December)
Winter (January - March)
Spring (March - June)
If you were to rank your preferred art discipline, which would be your first choice?
Please select...
Dance
Music
Theatre
If you were to rank your preferred art discipline, which would be your second choice?
Please select...
Dance
Music
Theatre
If you were to rank your preferred art discipline, which would be your third choice?
Please select...
Dance
Music
Theatre
If you selected music, please check off 1-2 instrument(s) below that you are most interested in focusing on.
Drums
Guitar/Bass
Piano
Voice
How did you find out about our program?
Please select...
Artes Culturales
I am a current or former participant
Family Member
Flyer
Friend
HSTF Community Event
Opportunity Fair
Social Media
School Presentation
School Field Trip to HSTF
Teacher
Other
If you selected Family Member, Friend, Other, or Teacher above, please write their name below.
Our Jóvenes en Acción (JEA) program is year-round. Would you be interested in joining JEA during the school year also?
Please select...
Yes
No
Maybe
Why are you interested in joining our program?
What are you hoping to take away from our program?
Participant Information
Address Line 1
Address Line 2
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Zip Code
Youth Email
Home Phone number
Youth Cell Phone number (if available)
Date of Birth
Format MONTH/DATE/YEAR
Age
Please select...
12 years old
13 years old
14 years old
15 years old
16 years old
17 years old
18 years old
19 years old
Gender
Please select...
Female
Male
Non-Binary
Prefer Not To Say
Gender Questioning
Gender Transitioning
Prefer to Self-Describe
If you selected "Prefer to Self-Describe" please do so below.
Which of the following best describes you?
Asian or Pacific Islander
Black or African American
Hispanic or Latino
Native American or Alaskan Native
White or Caucasian
Multiracial or Biracial
A race/ethnicity not listed here
If you selected "Multiracial or Biracial" or "A race/ethnicity not listed here" please describe below.
Country of Birth
Please select...
Brazil
Cape Verde
Colombia
Costa Rica
Cuba
Dominican Republic
Ecuador
El Salvador
Guatemala
Haiti
Honduras
Jamaica
Mexico
Other
Panama
Peru
Puerto Rico
United States
Venezuela
What school do you currently attend?
Please select...
Academy of the Pacific Rim
Another Course to College
Boston Arts Academy
Boston Collegiate
Boston Day & Evening
Boston Green Academy
Boston International Newcomers Academy
Boston Latin Academy
Boston Latin School
Boston Preparatory
Boston Teachers Union School
Brighton High
Brooke High
Burke High
Charlestown High
City on a Hill (Dudley)
Codman Academy
Community Academy of Science and Health
Conservatory Lab Charter School
Curley
Dearborn STEM Academy
East Boston High
Edward M. Kennedy Academy for Health Careers
English High
Excel High
Fenway High
Greater Egleston High
Hennigan
Madison Park
Margarita Muniz Academy
MATCH High
MATCH Middle
Meridian Academy
METCO
New Mission High
O'Bryant
Roxbury Preparatory
Ruth Batson Academy
Snowden International
TechBoston Academy
UP Academy Dorchester
Young Achievers Science and Math
Other
If you selected "other or METCO," please write in the name of your school below.
What grade are you in?
Please select...
8th
9th
10th
11th
12th
Other
Parent/Guardian Information
Parent/Guardian First and Last Name
Relationship to Youth
Home Phone Number
Cell Phone Number
Email Address
Parent/Guardian Country of Birth
Please select...
Brazil
Cape Verde
Colombia
Costa Rica
Cuba
Dominican Republic
Ecuador
El Salvador
Guatemala
Haiti
Honduras
Jamaica
Mexico
Panama
Peru
Puerto Rico
United States
Venezuela
Other
Is the parent/guardian address the same as the youth's address listed above?
Yes
No
Parent/Guardian Address:
Consent to Receive Texts from Hyde Square Task Force
Preferred Method of Communication:
Email
Text
Phone Call
What is your preferred language?
By providing a telephone number and submitting this form you are consenting to be contacted by SMS text message. Message & data rates may apply. Message frequency may vary. Reply Help for more information. You can reply STOP to opt-out of further messaging. To read our privacy policy,
click here
.
Yes, I understand
Signatures for Submission
The information provided on this form is true and accurate to the best of my knowledge and both the parent and applicant are aware that this application is being submitted.
Yes, I agree
Parent/Guardian Signature
Participant Signature
Today's Date
For more information on our privacy policy,
click here
.
Contact Information