Shore Corps Program Online Registration Form

Participants must be ages 14-19.(Students must be age 14 by September 1st to be eligible to apply). 

Form fields with * are required to register.
Please contact us if you have any questions.

Program Information

Student Information

Month / Day / Year

Example: 718-555-1212

Email is the primary means of communication throughout the program. Be sure you check the email address you provide to us frequently. For Shore Corps, Urban Planning and Environmentor, teens will be the point of contact for all program communication. Parent/Guardians will be copied upon request. If you do not have regular internet access, please let us know and we will work to accommodate you.

Emergency Contact 1

Emergency Contact 2

About You

Month / Year

Please select all that apply...

 Community Service Projects
 Paid Internship
 Field Trips
 College Visits
 Scholarship Opportunities
 Summer Camp
 Urban Planning
 Scientific Research
 Leadership Development