Y-SCHOLARS PROGRAM
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    YOUTH INSTITUTE SUMMER ACADEMY APPLICATION

    STUDENT INFO


    Parent/Guardian Information

    Father, Mother, Etc
    Father, Mother, Etc

    Emergency Contact/Child Release Authorization

    The YMCA-PG&E Teen Center has my unrestricted permission to release the named minor at any time to the following individuals and to contact them in case of an emergency if the parent(s)/guardian(s) are unavailable:

    Participant Health Information

    To be completed by parent/guardian. If your child has special needs, please let us know.


    Personal Questions
    ​(We thank you in advance for being open to people you do not even know)

    ​All questions need to be answered by the student.

    BERKELEY YOUTH INSTITUTE SUMMER ACADEMY COMMITMENT CONTRACT
    Summer Academy Schedule Commitment

    Summer Academy Attendance and Effort Commitment

    Student and parent/guardian, please read these statements below, check each box to agree to each statement. 
Submit

FOLLOW US

CONTACT US

Audi Huang
YSP Director
510-542-2121
ahuang@yscholars.org
Dolores Blackman
YSP Manager
510-630-6105
dblackman@yscholars.org

    Send us a QUESTION
    ​OR A MESSAGE!

Submit

LOCATION

  • Home
  • About
    • Our WHY
    • Our CULTURE
    • Our TEAM
  • Y-Scholars
    • Membership
    • Alumni >
      • Update Contact Information
      • Alumni FAQ
  • Events
    • College Mindset Academy >
      • CMA Application
  • Get Involved
    • Jobs >
      • Positions
    • Volunteer >
      • Senior Advisor
    • Partnerships
  • DONATE