YouthWorks Application

Participant Information

Which Program Year are you interested in?

Program Year: If you are starting a Program in May of this year to end of May of the next Year, select a PY starting with the current year. If you are starting a Program in June or later next year, pick the PY starting with next year

Cycle

How did you hear about us?

Preferred Name

Legal First Name

Last Name

Pronouns

Date of Birth

Age at the start of programming, if different from above

Personal Email

Alternate Email Address

Phone Number

Street Address

City

State

Zip Code

Ethnicty

Hispanic or LatinoNot Hispanic or LatinoPrefer Not to Disclose

Other Race

Local Program Grant Information

.If you are enrolled in a shop, vocational program or career pathway at school, what program?

Are you currently or have you in the past been enrolled in any of the following school programs or received any of the following services in school?

Other Services

Participants Under 18

Participants under the age of 18 need permission from a guardian to participate in programming.

Name of Parent/Guardian

Parent/Guardian Email

Parent/Guardian Phone Number

Emergency Contact

The information of an emergency contact is necessary in the event of an emergency.

Name of Emergency Contact

Relationship of Emergency Contact

Phone Number of Emergency Contact

Skills and Interests

List some of the skills and talents you have that you could use in a job. Examples: computer skills, teaching skills, sports-related skills, artistic skills, or being fluent in another language.

What type of job are you interested in?Examples: working with children, working outdoors, working in an office setting, etc

Each year, YouthWorks provides opportunities for participants to gain work experience, earn money, and gain soft skills at businesses and organizations throughout the community. PLEASE TELL US ABOUT YOURSELF, including the strengths and skills you can bring to this program and any goals you would like to accomplish through this program.