APPLY

Before filling out the application please confirm you can commit to attend all 6 weeks.

Verify that you have reliable transportation to attend workshops, internships, and other events.

ACADEMY DATES

BERKS COUNTY: June 8 - July 31

First Name*

Last Name*

Preferred Name/Nickname*

How to Pronounce Your Name (optional)

School District*

Email Address (not school)*

Home Address - Street*

City*

State*

Zip Code*

County*

Cell Phone*

Date of Birth*

T-Shirt Size (unisex)*

Do you have dependable transportation?*

Y

N

Do you have family members who are entrepreneurs (own a business)?

Y

N

Why are you interested in the Emerging Entrepreneur Academy and where might you want to intern?(short answer)? *

RECOMMENDED BY: Name*

Recommended by: Email*

Recommended by: Phone*

SCHOOL Type*

Current Grade

PARENT/LEGAL GUARDIAN First Name*

Parent/Legal Guardian Last Name*

Parent/Legal Guardian (Cell) Phone*

Parent/Legal Guardian Email Address*

Parent/Legal Guardian Relationship*