Membership

PLEASE COMPLETE THE FORM TO APPLY FOR MEMBERSHIP:

Eligible applicants should be between the ages of 12-21 and live in the Atlanta Metropolitan area:

Membership Application:

First Name

Last Name

Nickname

Address

City

State

Zip Code

Email Address

Home Phone

Cell Phone

Birth Place/City

Birth Date

Age

Profile Image

How did you hear about The PROPEL Initiative?

School Relative Teacher Friend Brochure Other

School Information

Are you currently attending school? Yes No

If yes Middle High School College

Grade Level

Name of School

Family Information

Family Household Size: 1 2 3 4 5 6 7 8 Other

Family Type Two Parent Household Single Parent Household Foster Family Other

Employment Information:

Are you currently employed: Yes No

If you are currently employed, please provide the following:

Employer:

Address:

Telephone #:

Membership Questionnaire:

This section is intended for us to get to know you and better address your needs and interests.

Fill out with as much information as possible.

Are you currently involved in any extracurricular activities? (Sports, Clubs, Organizations etc.)

What are your hobbies? (Skating, reading, Music, etc.)

What are your major strengths?

What are your major weaknesses?

What are your goals for the next 2 years?

What do you plan to do after high school?

What career do you want to pursue?

What would you like to get from The PROPEL Initiative?

Below are some of the regular activities The PROPEL Initiative provides for participants. Please select the ones that interest you. Cooking Class Health Awareness Financial Literacy 1-1 Mentoring College Campus Tours Sewing Community Service Events Summer Camp Retreat Field Trips

Other activities you would like to participate in and see in the program:

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