Enrollment Form

Alaska Communications Center

4640 Old Seward Highway, Suite 203

Anchorage, AK  99503

907-563-5226

Fax:  907-563-5224

Project Director email:  katy.parrish@kacn.tv

Name:                                                                                                  Age:                       Ethnicity:                             Sex:      

Mailing address:                                                                                                                                                                              

Phone:                                                 Email:                                                                                                                                   

Tell us your story:

What are your strengths?

What has been difficult for you in school or in finding a job?

Why are you interested in Learn, Earn & Serve?

What are your dreams for the future?

Do you have access to a computer with high speed internet (can watch videos online without long wait times)?                                                Yes                         No

If Yes, how many hours a week can you use it and where is it?  (School computers may have filters that might interfere with some of the resources we want to share.)

Thank you.  I will be calling you within one day of you returning this form.  When is the best time for me to call you?