YBL Student Application Form

  • YouthBuild Louisville: Student Application

    YouthBuild Louisville is dedicated to providing the most comprehensive service for each participant, and in order to ensure YouthBuild’s ability to best serve you, the following form must be completed thoroughly. Please fill out each item as directed.
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  • Education:

  • Do you have your High School Diploma? (HSD)*
  • Do you have your GED?*

  • Eligibility

  • Gender*
  • US Citizen Status*
  • Authorized to work in the US?*
  • Registered to Vote?*
  • Do you have your Driver's License?*
  • Registered for Selective Service? (NOTE: If you are Male and 18 years old, you MUST be registered. We will help you complete this process.)*
  • Employment Status as of today:*
  • Race*
  • Marital Status:*
  • Household Income:*
  • Public Assistance (Indicate ALL that apply as of today)*
  • Check all that apply to you:*
  • How did you hear about YouthBuild Louisville?*
  • Fields of Interest:*

  • Job Skills & Training

  • Do you have a resume?  If so, upload it below.  Do you have other skills you would like to tell us about? Have you attended any trainings or have any certifications you would like us to know about? If so, list those in the appropriate areas below.  

  • YouthBuild Louisville is an equal opportunity organization and will not allow discrimination based upon age, ethnicity, ancestry, gender, national origin, disability, race, size, religion, sexual orientation, socioeconomic background, or any other status prohibited by applicable law.

    If reasonable accommodation is needed, please contact us at 502-290-6121. YouthBuild Louisville is committed to the full inclusion of all qualified individuals. As part of this commitment, YouthBuild Louisville will ensure that persons with disabilities are provided reasonable accommodations.

  • Signature

    I HEREBY CERTIFY THAT THE ANSWERS GIVEN BY ME ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I FURTHER CERTIFY THAT I, THE UNDERSIGNED APPLICANT, HAVE PERSONALLY COMPLETED THIS APPLICATION. I VERIFY BY MY SIGNATURE THAT THE ABOVE ADDRESS IS MY CORRECT LIVING ADDRESS. I HEREBY AUTHORIZE YOUTHBUILD LOUISVILLE TO THOROUGHLY INVESTIGATE MY WORK RECORD, EDUCATION AND OTHER MATTERS RELATED TO MY SUITABILITY FOR ACCEPTANCE INTO THE PROGRAM. PLEASE ENTER YOUR INITIALS IN THE SPACE BELOW, INDICATING YOUR AGREEMENT TO THE TERMS LISTED ABOVE. YOUR INITIALS IN THE SPACE BELOW ACT AS YOUR SIGNATURE TO THIS DOCUMENT.
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