Youth Social Work (YSocialWork) Certification Interest Form
Thank you for your interest in YSocialWork's Youth Social Work Certification Program. This interest form is designed to summarize your educational and career interest in social work. Please complete the entire form and submit it to YSocialWork, Inc. for further review. Interest forms are due February 10, 2021. Program dates: February 22, 2021 to March 31, 2021.
Currently, the Spring 2021 session is now full. We are now recruiting for other cohorts for PGCPS high school students.
Summer 2021
Fall 2021
Spring 2022
Summer 2022
Fall 2022
Spring 2023
Which program are you requesting to receive service-learning hours for? (Click All That Applies)
High School Student Experiential Classroom (Prerequisite)
Experiential Service-Learning in Social Work
International Service-Learning Capstone in Social Work
High School Student Webinars
Youth Advisory Council
Name of High School
Student Name
First Name
Middle Name
Last Name
High School Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
Gmail only.
High school grade level:
Freshman
Sophomore
Junior
Senior
Counselor Name:
First Name
Last Name
Counselor Email Address:
example@example.com
My culmative GPA is:
Enter GPA
.
My GPA as of last semester was:
Enter GPA
.
Total hours completed of community service:
*
Total number of hours required upon graduation:
*
Which semester do you intend to enroll in college?
*
Fall 2021
Spring 2022
Fall 2022
Spring 2023
Where are you in the college admissions process:
*
I am studying to take the Accuplacer, SAT, or ACT and have not submitted any college applications, but would like to learn more about a career in social work.
I have successfully completed Accuplacer, SAT, or ACT but have not submitted any college applications, but would like to learn more about a career in social work.
I have successfully completed all the college admissions requirements and would like to learn more about a career in social work.
I am considering social work as a major and have been accepted into a CSWE-accredition institution.
Are you currently enrolled in courses under PGCPS's Career and Technical Education Program, and if so, which one:
*
Architecture and Design
Business and Finance
Consumer Services, Hospitality, and Tourism
Engineering and Science
Environmental Studies
Graphic Arts, Media, and Communications
Health and Biosciences
Homeland Security and Emergency Preparedness
Information Technology
Human Resource Service (Possible Careers: Social Worker, Teacher, and Early Childhood Provider)
Fire Cadet Program
Transportation
The courses below are general education requirements outlined by CSWE-accredited programs for bachelor-degree seeking students in social work. Check the following courses you have completed prior to the start of the YSocialWork Certification Program:
*
English Grade 9 through 10
Psychology (PGCPS Course Code: 220000)
Local, State, and National Government (PGCPS Course Codes: 213103, 213143, 213153, 213163)
Anthropology (PGCPS Course Code: 290600)
Deliberate Talk (PGCPS Course Code: 291010)
Human Growth and Development through Adolescence (PGCPS Course Code: 686403)
Practical Law (PGCPS Course Code: 290700)
Civil Rights Law (PGCPS Course Code: 291200)
Sociology (PGCPS Course Code 290610)
What type of social work might interest you the most:
*
Case management (generalist)
Clinical social work
School social work
Health care social work
Political social work (macro social work)
Nonprofit leadership (macro social work)
Program management (macro social work)
Financial social work (macro social work)
What life experiences have influenced your decision to help others?
*
Share your favorite quote, and by who?
*
Are you available to attend orientation on Tuesday, February 16 at 5:30 PM?
*
Yes
No
The total number of hours towards social work competency-based education requires 12 hours of community service. However, students are able to earn a total of 25 hours by the end of the program.
Are you available to commit to one hour of online instruction each week from February 22 to March 31?
*
Yes
No
The total number of hours towards social work competency-based education requires 12 hours of community service. However, students are able to earn a total of 25 hours by the end of the program.
Are you available to complete 12- hours of community services with YSocialWork's instructors throughout the certification process?
*
Yes
No
If selected for this program, which one of the following debate topics would you want to debate at the end of the classroom experience:
*
Social media has improved human communication.
Healthcare should be universal.
All schools should have armed security guards.
Abortion should be banned.
Sex work should be legal.
All people should have Universal Basic Income.
Climate change is the greatest threat facing humanity today.
Juveniles should be tried and treated as adults.
All people should have the right to own guns.
All policing should be abolished and replaced with social workers.
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Parent Name:
*
First Name
Last Name
Parent Phone Number
*
-
Area Code
Phone Number
Parent Email:
*
example@example.com
Relationship to Participant:
*
Does YSocialWork have permission to record your student throughout the session for educational purposes:
*
Yes
No
YSocialWork, Inc. is requesting permission for the use of images, video, photo, and digital recording of your child, captured during the High School Experiential Classroom, for the purposes of YSocialWork, Inc. promotional material and publications, and waive any rights of compensation or ownership thereto..
Parental Acknowledgement: I certify that my child has permission to participate in this 6-week program to satisfy community service hours required upon graduation.
*
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What is your gender?
Female
Male
Non-binary
Do you consider yourself transgender?
Yes
No
I do not know.
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