Program Application
Print neatly in ink or type all answers. Email your completed application to , fax to
510-208-4965, or mail to 1225 Fallon Street, Room 900, Oakland, CA 94612 by THURSDAY, NOVEMBER 9th
by 4:00pm. This application can also be found at: DAJA is for juniors and seniors who attend public high school in and are residents of Alameda County. School districts for DAJA Tri-Valley include: Dublin, Pleasanton, and Livermore
A complete DAJA application includes: 1) signed parent/guardian permission form 2) your resume
3) pre-eligibility survey, and 4) program application. If you do not turn-in all four of these documents before or by the due date, you will not be considered for admission into the Academy.
Full Name: / Today’s Date:
Date of Birth: / Current Age:
Mailing Address: / City:
Zip: / Email Address:
Cell Phone: / Home Phone:
High School: / Graduation Year:
How did you hear about DAJA?
Have you applied to DAJA before? If so, When?
Justice Seminars are held twice monthly on Wednesdays at Dublin City Hall from 4:00-6:00pm. Public transportation assistance is available upon request.
Seminar Dates (Attendance is mandatory. Take note of these dates): 1/17/18, 1/31/18, 2/14/18, 2/28/18, 3/14/18, 3/28/18, 4/11/18, 4/25/18, 5/9/18, 5/23/18, 6/6/18, 6/20/18, 6/27/18, 7/11/18, 7/13/18
1) Attach your resume that outlines your work experience, volunteer experience, extra curricular activities, and/or awards.
2) Why do you want to participate in the District Attorney’s Justice Academy? Explain your response in 4-5 sentences (if you need more writing space, you may write your response on a separate sheet of paper and attach to your application).3) Do you participate in any after school activity including clubs, sports teams, work, etc. that would prohibit you from attending the Justice Academy Seminars?
4) Do you have any summer plans that will prohibit you from attending your summer work hours?
*Important: If you submit your application electronically compile your resume, pre-eligibility survey, parent permission form, and this program application into one PDF file and email to
1
District Attorney’s Justice Academy- Tri-Valley 2018
We are pleased that your student is interested in participating in the 2018 District Attorney’s Justice Academy. Admission to this Academy is an honor and we expect each participant to attend each Justice Seminar at Dublin City Hall twice monthly from 4:00-6:00pm and all summer internship hours. All seminar dates are listed on the program application. If your son/daughter is unable to attend a Seminar and/or work due to illness, he/she is required to call staff ahead of time. This form is to be completed and submitted with the program application in order for the applicant to be considered for admission.Parent/Guardian: Sign below to demonstrate that you have read and understood the program requirements.
I have reviewed the Justice Seminar dates on the program application and confirm that my student will attend the Seminars twice monthly from 4:00-6:00pm at Dublin City Hall in order to continue participating in the Justice Seminars and be eligible for the paid summer internship.
I confirm that my student is available to work all summer internship hours from Monday, June 11th or June 18th (depending on your child’s last day of school) to Friday, July 6th or July 13th 2018 (depending on your child’s internship start date).
I understand that failure to participate in the Justice Academy Seminars, work hours, and closing ceremony could result in my student’s termination from the District Attorney’s Justice Academy.
Parent Name (Print):
Parent Signature: / Date:
Student: Sign below to demonstrate that you have read and understood the program requirements.
I have reviewed the Justice Seminar dates on the program application and confirm that I will participate in the Justice Seminars twice monthly from 4:00-6:00pm at Dublin City Hall in order to continue participating in the Justice Seminars and be eligible for the paid summer internship.
I confirm that I am available to work all summer internship hours from Monday, June 11th or June 18th (depending on your last day of school) to Friday, July 6th or July 13th 2018 (depending on your internship start date).
I understand that failure to participate in the Justice Academy Seminars, work hours, and closing ceremony could result in my termination from the District Attorney’s Justice Academy.
Student Name (Print):
Student Signature: / Date:
*Important: If you submit your application electronically compile your resume, pre-eligibility survey, parent permission form, and this program application into one PDF file and email to
1
District Attorney’s Justice Academy- Tri-Valley 2018
District Attorney’s Justice Academy- Tri-Valley – Eden – North CountyEDUCATION & EMPLOYMENT PROGRAMS
Pre-Eligibility Survey
Complete this form and submit with your other DAJA application documents. If you are selected to participate in the DA’s Justice Academy, this information could allow the program to provide additional resources for you.
Name: / Date of Birth:
Age: / Gender: / M / F / Race/Ethnicity:
Home Address, City, Zip:
Home Phone: / Cell Phone:
Alternate Phone: / E-mail:
Parent/Guardian: / Primary Language Spoken in home:
Are you eligible to work in the United States? ☐Yes ☐No
Do you live with either of your parents?☐Yes ☐No
Do your parents claim you on taxes?☐Yes ☐No
How many people are in your household, under the age of 21?
Are you receiving Free or Reduced Lunch?☐Yes ☐No
Are you graduating this year?☐Yes ☐No
Are you currently on probation?☐Yes ☐No
Are you currently considered a foster youth?☐Yes ☐No
Are you receiving Cal-Learns / Cal-WORKS?☐Yes ☐No
Do you or your family receive food stamps?☐Yes ☐No
Do you or your family receive General Assistance?☐Yes ☐No
Are you couch surfing or homeless?☐Yes ☐No
Are you pregnant or parenting?☐Yes ☐No
Do you have a diagnosed disability of any kind?☐Yes ☐No
1
District Attorney’s Justice Academy- Tri-Valley 2018