Powerhouse Student Application

Student Information

First Name *This question is required.

Last Name *This question is required.

Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Street Address *This question is required.

Apt/Suite

City *This question is required.

Zip *This question is required.

Email Address *This question is required. This question requires a valid email address.

Primary Phone Number *This question is required.

Secondary Phone Number

If you said other, please specify.

Preferred language/s *This question is required.

Arabic
Chinese (Mandarin, Cantonese)
English

French
Korean
Somali

Spanish
Swahili
Tagalog

Vietnamese
Other

If you said other, please specify.

Are you currently in High School? *This question is required.

If you are not in high school, please describe. *This question is required.

Current School *This question is required.

Have you Completed the Powerhouse Career Assessment? *This question is required.

If you have completed the Powerhouse Career Assessment, mark the letters of your top TWO scores.
If you have not completed the Powerhouse Career Assessment, mark the TWO letters that most describe you. *This question is required.

D: (Dominance) Tends to place emphasis on accomplishing results and "seeing the big picture."Can be a "natural leader". They are confident, sometimes blunt, outspoken, and demanding.
I: (Influence)Tends to place emphasis on influencing or persuading others. Can be a "natural entertainer". They tend to be enthusiastic, optimistic, open, trusting, and energetic.
S: (Steadiness)Tends to place emphasis on cooperation, sincerity, loyalty, and dependability. They tend to have calm, deliberate dispositions, and don't like to be rushed.
C: (Conscientiousness) Tends to place emphasis on quality and accuracy, expertise and competency.They enjoy their independence, demand the details, and often fear being wrong.

Your Career Interests
Powerhouse seeks to match mentors with students who have similar career paths and interests. Please choose from the career clusters/industries below all in which you have interest. (limit 3) *This question is required.

Science and Technical
Social Services
Transportation and Logistics
Vocational/ Tradesman

Interests *This question is required.

If you said other, please specify.

Have you (the student) ever been involved with the Juvenile Justice System? *This question is required.

Powerhouse Student Application

Welcome