Summer workshop application


Name: __________________________________________

Home street address:

____________________________________________________________

City: __________________________________

Zip Code: __________________

Home phone number: ________________________


E-mail address (please print clearly):

_________________________________________

Grade you will enter in September: ________

Date of birth: ___________________

School you attend: ____________________________________

To apply fill out this form. Send it along with a check for $75 made out to L.A. Youth and a one-page writing sample about one of your interests, hobbies or activities to:

L.A. Youth
5967 W. 3rd St.
Suite 301
Los Angeles, CA 90036

Deadline: June 4, 2010