VI. Parent/Guardian Signature REQUIRED Firma REQUERIDA - Padre o Tutor legal I have reviewed this application, and I authorize my son/daughter/ legal ward to apply to join Big Citizen HUB. He revisado esta solicitud, y autorizo a mi hijo/hija a solicitar su adhesión a Big Citizen HUB. _____________________________________________________________ Printed Name/Nombre _____________________________________________________________ Signature/Firma _____________________________________________________________ Date/Fecha PROGRAM APPLICATION WHY JOIN? DO fun service projects such as: Painting MURALS, WORKING with the homeless & PLANTING community gardens! MEET new FRIENDS & different people from all over Los Angeles! BE a LEADER and MAKE a difference in YOUR community! If you are up to the CHALLENGE, and ready to make a COMMITMENT, APPLY TODAY! To apply to Big Citizen HUB: NOW ACCEPTING APPLICATI ONS! APPLICATION DEADLINE: Friday, November 21st! If you have any questions, contact Executive Director, Mario Fedelin at (213) 700-9940. 1. Fully complete the application, including all short answer questions. 2. Have your parent/guardian sign the application. 3. Ask a teacher, coach, or adult mentor to complete the recommendation form. 4. Return the completed application and recommendation form to: Your school’s Big Citizen HUB contact person Or Mail To: Big Citizen HUB, 1532 W. 11th Street Los Angeles CA 90015 I. About You Name: _____________________________________________________________ (OPTIONAL) ADDITIONAL GUARDIAN CONTACT INFROMATION: (OPCIONAL) CONTACTO ADICIONAL PARA PADRE O TUTOR LEGAL: Address: ___________________________________________________________ (street & apt. #) (city, state, zip) Home Phone #: ______________________________________________________ Cell Phone #: ________________________________________________________ Name/Nombre: _____________________________________________________ Relationship to Applicant/Relación a candidato/a: _______________________ Address/Domicilio:___________________________________________________ Gender: Male Female ____________________________________________________________________ Birthdate:_________________________ Age:__________ Grade: ___________ Phone/Telefono: (home/hogar)________________________________________ E-mail: _____________________________________________________________ How did you find out about us? (Please check one below) __ Presentation at school __ Another Program:_____________________ __ Friend __ Media/ Flyer __ Family __ Teacher __ School Guidance Office __ Other:_______________________________ Ethnicity: (please circle one below) (optional) African-American/Black Multiracial/Other Caucasian/White Hispanic/Latino(a) Asian American/ Pacific Islander American Indian/Alaskan Native II. About Your Parent(s)/Guardian(s) Información sobre tus padres o tutor (es) legal PRIMARY GUARDIAN CONTACT PADRE O TUTOR LEGAL PRINCIPAL Name/Nombre: _____________________________________________________ Relationship to Applicant/Relación al candidato/a:________________________ Address/Domicilio:___________________________________________________ ____________________________________________________________________ Phone/Telefono: (home/hogar) ________________________________________ (cell or work/ cellular o trabajo) ________________________________________ (cell or work/ cellular o trabajo) ________________________________________ III. About Your School School Name: _____________________________________________ Principal’s Name: __________________________________________ IV. Short Answer Questions Please answer the questions below on a separate piece of paper. 1) Why do you want to be a part of Big Citizen HUB? 2) How do you think young people can make a difference in the community? 3) Is there someone in your community you look up to? Tell us about that person and why you look up to him/her? 4) Tell us something interesting about yourself. Do you have any hobbies or interests? Do you participate in any activities or have any volunteer experience? Additional Materials If you would like to share creative materials (poetry, photos, drawings, etc.), please include them with your application!