Sign Up Now to Start Our Program! - April 2019 Orientation Fill out this form and a member of our team will contact you to get started. Name* First Last Phone*What is the best number to reach you? This number is...My cell phoneMy home phone (landline)A friend or relative's cell phoneA friend or relative's home phone (landline)Email (Optional)Birthdate*mm/dd/yyyy (example: 01/15/1999)Do you have a high school diploma?*YesNoHave you ever attended Civicorps before?*YesNoI have interviewed but not attended.How did you hear about Civicorps?A friend or family memberA caseworker or counselorA Facebook or Instagram AdA Snapchat AdNameThis field is for validation purposes and should be left unchanged.