Youth Social Work (YSocialWork) Certification Interest Form

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. Program dates for Fall 2021: October 12, 2021 to November 17, 2021.
Currently, the Fall 2021 session is almost full and seats are limited. We are also recruiting for other cohorts for high school students.
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 Summer Internship
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:
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? *
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 Career and Technical Education Program? *

Yes No
If so, which one are you affiliated with: *

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 I am not affiliated with any CTE programs of study.
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: (Codes are designated for PGCPS students only) *

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 (clinical) School social work (clinical) Health care social work (clinical) 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, October 5th, at 5:30 PM? *
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 October 12 to November 17? *
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? *

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: *
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. *

Clear

What is your gender?
Do you consider yourself transgender?
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