Youth Name *

First Name

Last Name

Youth's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Youth Phone *

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Birth Date *

MM

DD

YYYY

Gender *

Male

Female

Neutral

Parent/Guardian Name

Skip if you are over 18

First Name

Last Name

Parent/Guardian Phone

Skip if you are over 18

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I am over 18, I am interested in additional job responsibilities and receiving a higher stipend. I understand this intern position supports program staff and participates in the El Mercadito Farmers Market every Tuesday 3pm-8pm. *