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Apply for the EJSLA Program

Environmental Justice STEMM Leadership Development Program

Begin your application process by completing the web form below or downloading the PDF version of the Student Application combined form.

Fall 2023 Spring 2024 Student Application Combined[74].pdf

Spring 2024 Student Application Combined Form

Interested in volunteering with EJSLA? Download the PDF version of the volunteer application.

Volunteer Application for EJSLA Educator

Program Application Form

Student Information:

First name

Last name

Age

Date of Birth

Grade level

T-Shirt Size

Street Address

Street Address Line 2

City

State

Zip code

Race/Ethnicity

American Indian or Alaska Native

Asian

Black or African American

Hispanic/Latino

Native Hawaiian or Other Pacific Islander

White

Two or More Races

Other

Club Location You Attend

East Biloxi

D'Iberville

Forest Heights

Pass Christian

Parent/Guardian Information

Mother's Full Name

Mother's Cell Phone

Name of Guardian (if different from mother or father)

Father's Full Name

Father's Cell Phone

Relationship to Guardian

Guardian Cell Phone

Parent/ Guardian Email

Parent/Guardian Address

Thanks for applying to our Program! We'll get back to you soon.

*Acceptance to the EJSLA program is not guaranteed

APPLY TO EJSLA

LEARN HOW TO APPLY FOR THE EJSLA PROGRAM OR BECOME A VOLUNTEER.

APPLY FOR PROGRAM

Contact Us

Let's work together to better our community. Contact us to discover how we can help you or a student achieve their goals

Thanks for submitting!

ADDRESS

PHONE

EMAIL

228-435-3113

11975 Seaway Road

Suite B225

Gulfport, MS 39503

ejsla@stepscoalition.org

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