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After School Program Application

Are you a high school age student interested in art, design and public health? Are you interested in how the arts can address our city's most pressing problems? Join our weekly After School Program and interact with Philadelphia's many arts and social advocacy organizations. The program meets during the school year and is free.

The After School Program at Slought meets weekly during the 2017-2018 school year and accommodates up to ten participants (ages 14-18) from local high schools. The program is free.

We are currently accepting applications on a rolling basis. Contact Anastasia Colzie and Akili Davis for more information.

<div class="field-row">


<div class="field-row">
    <input class="narrow" type="text" name="name" placeholder="Your Name" value="" />
    <input class="narrow" type="text" name="preferred_name" placeholder="Preferred Name"  value="" />
    </div>

<div class="field-row">
    <input class="narrow" type="text" name="date_of_birth" placeholder="Date of Birth" value=""/>
    <input class="narrow" type="text" name="school" placeholder="Are you in School? Where?"  value=""/>
    </div>

<label for="form-text">Contact Information</label>

<label for="form-street"></label>

<input type="text" id="form-text" name="address" placeholder="Home Address" value=""/>

<div class="field-row">
    <input class="narrow" type="text" name="zip" placeholder="Zipcode" value=""/>
    <input class="narrow" type="text" name="phone" placeholder="Phone" value=""/>
</div>

<div class="field-row">
    <input class="narrow" type="text" name="neighborhood" placeholder="Neighborhood" value=""/>
    <input class="narrow" type="text" name="email" placeholder="Email" value=""/>
</div>



<label for="form-text">Tell us what you like about your neighborhood.</label>
<textarea id="form-text" name="your_neighborhood" cols="50" rows="3"></textarea>

<label for="form-text">What social issues concern you?</label>
<textarea id="form-text" name="your_social_issues" cols="50" rows="3"></textarea>

<label for="form-text">What artists, activists or scholars have shaped your views about these issues?</label>
<textarea id="form-text" name="your_influences" cols="50" rows="3"></textarea>

<label for="form-text">Tell us about a positive group experience that you have had? </label>
<textarea id="form-text" name="your_team_expectations" cols="50" rows="3"></textarea>

<label for="form-text">Is there anything else you would like to tell us about yourself?</label>
<textarea id="form-text" name="additional_questions" cols="50" rows="3"></textarea>


<label>Your Parent/Guardian</label>

<div class="field-row">
<input class="narrow" type="text" name="guardian_phone" placeholder="Phone" value="" />
</div>


<label>Emergency Contact Information</label>

<div class="field-row">
<input class="narrow" type="text" name="emergency_phone" placeholder="Phone" value="" />
<input class="narrow" type="text" name="emergency_phone2" placeholder="Phone #2" value="" />
</div>

<button class="button" type="submit">Apply</button>