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First Name
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Last Name
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Address 1
Address 2
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City
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State
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Zip Code
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Telephone (Home) (Cell)
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(Cell)
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Email Address
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DOB
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1.
Beginning with the most recent, please list the schools you have attended and any degrees you have received.
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2.
What language (s) do you speak and/or read?
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3.
Please list any employment experience(s) you have had and the years involved.
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4.
Please list any volunteer work that you have done and the years involved.
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5.
Please list any church activities in which you have been active.
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6.
How did you hear about this program?
7.
Please list the names, addresses and phone numbers of 3 people who know you and are willing to be a reference… teacher, coach, clergy or religious, employer.
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A. Name
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Telephone
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Address
Relationship to you
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B. Name
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Telephone
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Address
Relationship to you
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C. Name
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Telephone
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Address
Relationship to you
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8.
What do you hope to bring to this program?
What do you expect to receive?
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9.
How do you see this program in relation to your Christian faith and how you live Gospel values?
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Signature:
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Date:
Please return to:
Summer Volunteer Program
Sisters of Charity Center
6301 Riverdale Avenue
Bronx, New York
10471
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Indicates Response Required