Name

Home Phone

Cell Phone

Email address

Please add lfeinman@jcconthehudson.org to your trusted sender list so we can contact you by email with additional CIT program info.

Street Address

Zip Code    Date of Birth     Current Grade

School

Teams, clubs, other extra curricular activities or interests:

Volunteer Experience:

Work Experience:

References: Please list three people, other than your parents, whom you have worked with or for. (Babysitting clients, teachers, supervisors, etc.)

              Name              Relationship to applicant        Phone Number

1.

2.

3.

Why do you want to be a CIT?

Is there anything else you would like us to know about you?

Thank you for your application. 

We will contact you by phone or email to schedule an interview.