Full Name
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First Name
Last Name
Age
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Date of Birth
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MM
DD
YYYY
Email Address
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Phone Number
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(###)
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####
Home Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
T-shirt Size
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S
M
L
XL
2XL
Highest Level of Education
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Name of Institution, Degree Earned, and Year of Completion.
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Are You Currently in School?
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Please List Any Certificates, Certifications, or Licenses that you have earned.
Are You Currently Employed?
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Select the Age-Range(s) You Prefer to Work With:
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Are You Able to Work Between 2pm and 6pm?
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Our programs start directly after school and run for approx. 2hrs per session. Although school times vary, most programs will begin after 2pm and conclude before 6pm.
Which Day(s) Are You Available to Work Within the Timeframe Stated Above? (Select all that apply)
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Most of our after school programs take place Mon/Wed or Tues/Thurs. However, we will do our best to accomodate your availability.
Consent for Name & Image Release
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I hereby consent to the reproduction, publication, and other uses of my photographic or cinematic images, voices and/or property by Black Boys in Tech, BBIT Digital, and any programs of these organizations, however designated. I further consent to the use of the above-mentioned cinematic images or photographic likeness in any motion picture, television broadcast, advertisement, publication, online mediums, or programs at such time and in such places as the above-named organizations, separately or in partnership, and in their individual and joint discretion, shall determine. I also consent to the irrevocable right to use our names (and any fictional name), written copy and photograph for purposes outlined as in the above paragraph. I further grant the above-mentioned rights without compensation.
Consent for Background Check
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Applicant Signature
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