p.o. box 99 yea! program manager blairs, va 24547 (434) 836 … · 2019. 5. 23. · trina...
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Trina McLaughlin YEA! Program Manager (434) 836-6990 tmclaughlin@dpchamber.org
P.O. Box 99 Blairs, VA 24547 Fax: (434)836-6955
October 23, 2017
November 1, 2017
March 2018
May 2018
May 2018
May 2018
PART I – Student Information
Student Name Age DOB
Address City / State / ZIP
Student’s Email Address
School Current Grade Graduation Year
Parent / Guardian 1 Name Email Address
Place of Business Primary Phone
Parent / Guardian 2 Name Email Address
Place of Business Primary Phone
Recommender’s Name Recommender’s Affiliation
Recommender’s Email Address Recommender’s Phone
Academic year begins in October and ends in March Classes meet every Monday from 4:00 p.m. to 6:30 p.m.
Deadline for applications for the 2017–2018 year is
September 29, 2017.
Billing Zip Code: __________________ Credit Card Security Code: ________________
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