Racial Justice Rites of Passage Program Application – Application Deadline January 31, 2021
Questions marked by * are required.
1. Name (Last, Middle, First): *
2. Email: *
3. Date of Birth: *
4. Street Address: *
5. City: *
6. State: *
7. Zip: *
8. School Name: *
9. Grade: *
10. Age: *
11. GPA: *
12. Is this your first time participating in a Rites of Passage program?: *

  • Yes
  • No
13. How did you learn about the Rites of Passage Program?: *
14. What are your hobbies?: *
15. Do you participate in any extracurricular activities at school or in your
community? If so, please describe. *
16. Have you ever experienced racial bias, prejudice, bigotry or racism?
Please explain. *
17. Why do you want to participate in the Racial Justice Rites of Passage
Program? What do you hope to gain?: *
18. What are your career aspirations?: *
19. Please submit an updated resume. *
20. Student Electronic Signature: *
21. Date: *
22. Parent/Guardian Name (Last, Middle, First): *
23. Parent Phone Number: *
24. Parent/Guardian Email Address: *
25. Parent/Guardian Electronic Signature: *
26. Date 2: *