Illinois Summer Employment Student Interest Form




IMPORTANT - If you are a current Give Back student, please prefill this form using this link
Student Details



IMPORTANT: Your birthdate must be entered as Month/Day/Year (the "/" between each number is very important)!

Please enter the grade that you are presently in.
School Information


School Information


Please use the two letter abbreviation for your state.



Our communications tools allow us to send messages through SMS with program updates and invitations.  If the student does not have a mobile phone, please enter the primary caregiver's mobile number.

If you do not have a home phone number you may leave this space blank

Our communications tools allow us to send messages through email with program updates and invitations.  If the student does not have an email address, please enter the primary caregiver's email address.
Student mailing address



Please answer the following questions: