Bed Stuy | Foot Soldiers Application

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Please note everything with a asterisk * sign is required fields

Birth Place:*
Email Address*:
Date Of Birth:*
Legal Last Name:*
Legal First Name:*
Age:*
Preferred Name:
Current Neighborhood(e.g. Bed-Stuy, Brownsville)*:
ADDRESS INFORMATION
Street Number:*
Street Address:*
Apartment:*
City:*
State:*
Zip Code:*
PHONE INFORMATION
Home Phone:*
Alternate Phone:
Sex:*
How did you hear about PR-G? If you were referred by a person who?*:
EMERGENCY CONTACT INFORMATION

Guardian's Full Name:*
Guardian's Contact number:*
Relationship:*
EDUCATION INFORMATION
Are you in high school?:*
Are you in college?:*
School Name:*
Address:
City, State:
Can you obtain the following? Most Recent Report Card:*
If no why?:
Can you obtain a Current High School Transcript?:*
If no why?:
ROP PROGRAM OVERVIEW	CLICK HERE TO VIEW ROP OVERVIEW
Are you available to work between Sunday – Saturday 4:00p.m. to 7:00p.m.?*

If no, state which day’s you can’t work on?:
It is often required that you must commute from school or your home to different locations in Bed-Stuy, can you commute?*

If no, state why?:
Would you be willing to perform random community service projects?*

If no, state why?:
Are you willing to learn financial literacy?*

If no, state why?:
*required

ADDRESS INFORMATION