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Community Builders Chicago (CBC)
Summer Shadowing 2010

6263 N. McCormick Blvd, #250, Chicago, IL 60659
Tel. 877 882-2200 Fax. 847 568-9866

Application

 

First Name

 

Middle Initial

 

Surname

 

Date

 

Date of Birth

 

Age

 

Sex Choose Option Male Female

 

Home Telephone

 

Mobile

 

E mail

 

School Attending

 

Grade Level

 

College Attending

 

Year Level

 

What will be your major in College

Decided
Undecided

 

Career Interests

 

Choice 1:

 

Choice 2:

 

Choice 3:

 

Enrollment fee is $10 per student, payable to CBC.
For more info please call 877 882-2200

3 ways to enroll:

Fill the Form and Submit

Fax: 847 568-9866

Tel: 877 882-2200