| Application # | 371 |
|---|---|
| Application Submitted | December 13, 2023, 12:33 pm |
| Name | Talaiyaa Campbell |
| Address | 320 Date Palm Dr Lake Park Florida 33403 |
| DOB | 2004-12-06 |
| Age | 19 |
| talaiyaac@gmail.com | |
| Phone | 5616628720 |
| Emergency Contact | Tasanka Campbell |
| Emergency Number | 5616628720 |
| Drivers License | No |
| Tickets/Violations | No |
| Grade Completed | 12th grade |
| How did you hear about YATC? | Previous student |
| Automotive Experience | No |
| Where was your training? | |
| Do you have a job? | No |
| Place of Employment | |
| Hourly Wage | |
| Extra Comments |
