Student Name

Age

Date of Birth

Address/City/State/Zip

Students Email Address

Student Cell Phone Number

School

Grade as of September 2012

High School Graduation Year

Mother/Guardian

Home Telephone

Mother Cell Phone

Mother -
Place of Business
Business Phone
Email Address

Father/Guardian

Home Telephone

Father Cell Phone

Father - 
Place of Business
Business Phone
Email Address

Recommender's -
Name
Telephone
E-Mail Address
Affiliation to Student

How did you find out about the Boca Chamber Young Entrepreneurs Academy?

Please check your tuition payment option.  Plan must be selected before start of class.

Please write a brief response below to the following questions.  (1,000 words total for the 3 questions)

1.  Why are you interested in learning about entrepreneurship?
2.  If you are currently in the business of launching your own business (profit or not for profit) or you have a creative and innovative idea for a business, please describe.
3.  What entrepreneurial endeavor/story, either from the past or currently, inspires you?  Please describe.

Please write a brief essay (approximately 300 words) on the following topic. 

Successful entrepreneurs share similar characteristics, such as persistence, inquisitiveness, self-confidence, tolerance for failure, creativity, innovation, personal initiative, competitiveness, commitment, and strong management and organizational skills.  Describe a situation when you demonstrated at least two of these characteristics, and the outcome. 

I agree to have my school transcripts sent to the Boca Chamber YEA! program within 20 days of filling out this application.  bjohnston@bocaratonchamber.com

I agree to have a letter of recommendation sent to the Boca Chamber attention Beth Johnston within 20 days of filling out this application.  bjohnston@bocaratonchamber.com
The letter should address how long the recommender has known you and in what context, your academic abilities, level of maturity, social skills, commitment to the community, and other characteristics that demonstrate you are a good candidate for the program.  Letters of recommendation will remain confidential.

If my son/daughter is accepted as a student, I agree to abide by the Boca Chamber YEA! Program regulations and rules.  I understand that a payment plan must be selected and a deposit received and that no deductions or refunds will be given for late cancellations or expulsions.  Furthermore, I give permission for my son/daughter to attend all functions connected with YEA!, including any which may be held off campus.  I hereby release the Greater Boca Raton Chamber of Commerce, and the officers, trustees, employees, agents and volunteers of the aforementioned organizations for all actions, claims or demands for damages resulting from my son/daughters participation in the activities, and from liability and damages, injuries, or losses which might be sustained by my child, except those caused by the direct and sole negligence of the aforementioned organizations.

I understand that submitting an application does not guarantee acceptance into the Boca Chamber YEA! Program.