TC Parent Form 2015 .pdf

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Dear Parents,
Your child is invited to an in-person interview to join Genesys Works! Genesys Works is a non-profit
program that provides students with real-world skills training, a paid corporate internship, and college
counseling during their senior year. Below are upcoming events:

Things for family members to do:
1. Fill out the form on yellow paper and have your child bring it to their interview. All information
will be kept confidential.
2. Encourage your child to have an interview transportation plan: Many students get rides from
family members, classmates, or take public transportation to their interview. Please contact us if
you have any questions or concerns.
3. Learn more about the program: Visit our website at www.genesysworks.org/twincities.
4. Have a conversation with your child: Genesys Works is a great opportunity for students to get
real-world skills training, a paid internship during the school year, and help for college. Encourage
them to come to the interview.
We look forward to partnering with you! If you have any questions, we’d love to answer them! Email
Krystal at kstackhouse@genesysworks.org, or call our office at 651-789-0088.

KEEP THIS PAGE FOR YOUR RECORDS. HAVE YOUR STUDENT RETURN THE YELLOW FORM AT THEIR INTERVIEW!

Dear Parents,
Admission to Genesys Works includes factors such as school schedule, teacher/counselor
recommendations, and financial need.
Please answer the questions below and have your child bring this form to their Genesys Works
interview. We need this information to process their application.
This information will be kept confidential.
Thank you,
Jeff Tollefson
Executive Director

1. What is your total family income?
Below $21,000

$58,000 - $65,000

$21,000 - $28,000

$65,000 - $73,000

$28,000 - $36,000

$73,000 - $80,000

$36,000 - $43,000

$80,000 - $87,000

$43,000 - $51,000

More than $87,000

$51,000 - $58,000
2. How many individuals live in your household? ______
3. Special Circumstances You Would Like Considered (ex. health expenses, recent job changes):
_____________________________________________________________________________________
_____________________________________________________________________________________
I, the parent/guardian of the identified student, understand what the Genesys Works program entails,
and am willing to support my child during summer training and throughout the school year.
STUDENT NAME: ___________________________________________________________________
PARENT/GUARDIAN NAME: ___________________________________________________________
PARENT SIGNATURE: _________________________________________________________________
www.genesysworks.org/twincities /445 Minnesota Street, Suite 720 Saint Paul, MN 55101/651-789-0088


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