P.O. Box 99 YEA! Program Manager Blairs, VA 24547 (434) 836 … · 2019. 5. 23. · Trina...
Transcript of P.O. Box 99 YEA! Program Manager Blairs, VA 24547 (434) 836 … · 2019. 5. 23. · Trina...
![Page 1: P.O. Box 99 YEA! Program Manager Blairs, VA 24547 (434) 836 … · 2019. 5. 23. · Trina McLaughlin YEA! Program Manager (434) 836-6990 tmclaughlin@dpchamber.org P.O. Box 99 Blairs,](https://reader035.fdocuments.us/reader035/viewer/2022071413/610a79bf544e8c1da030ee0b/html5/thumbnails/1.jpg)
Trina McLaughlin YEA! Program Manager (434) 836-6990 [email protected]
P.O. Box 99 Blairs, VA 24547 Fax: (434)836-6955
![Page 2: P.O. Box 99 YEA! Program Manager Blairs, VA 24547 (434) 836 … · 2019. 5. 23. · Trina McLaughlin YEA! Program Manager (434) 836-6990 tmclaughlin@dpchamber.org P.O. Box 99 Blairs,](https://reader035.fdocuments.us/reader035/viewer/2022071413/610a79bf544e8c1da030ee0b/html5/thumbnails/2.jpg)
October 23, 2017
November 1, 2017
March 2018
May 2018
May 2018
May 2018
![Page 3: P.O. Box 99 YEA! Program Manager Blairs, VA 24547 (434) 836 … · 2019. 5. 23. · Trina McLaughlin YEA! Program Manager (434) 836-6990 tmclaughlin@dpchamber.org P.O. Box 99 Blairs,](https://reader035.fdocuments.us/reader035/viewer/2022071413/610a79bf544e8c1da030ee0b/html5/thumbnails/3.jpg)
PART I – Student Information
Student Name Age DOB
Address City / State / ZIP
Student’s Email Address
School Current Grade Graduation Year
Parent / Guardian 1 Name Email Address
Place of Business Primary Phone
Parent / Guardian 2 Name Email Address
Place of Business Primary Phone
Recommender’s Name Recommender’s Affiliation
Recommender’s Email Address Recommender’s Phone
Academic year begins in October and ends in March Classes meet every Monday from 4:00 p.m. to 6:30 p.m.
Deadline for applications for the 2017–2018 year is
September 29, 2017.
![Page 4: P.O. Box 99 YEA! Program Manager Blairs, VA 24547 (434) 836 … · 2019. 5. 23. · Trina McLaughlin YEA! Program Manager (434) 836-6990 tmclaughlin@dpchamber.org P.O. Box 99 Blairs,](https://reader035.fdocuments.us/reader035/viewer/2022071413/610a79bf544e8c1da030ee0b/html5/thumbnails/4.jpg)
Billing Zip Code: __________________ Credit Card Security Code: ________________