YouthBuild Participant Application

YouthBuild Participant Application
Housing Authority of Champaign County YouthBuild’s Mission…

is to offer young people a once in a lifetime opportunity to build their futures and their community through education, leadership development, job training, and the rehabilitation and development of affordable housing.

ENROLLMENT REQUIREMENTS
Eligibility	Documentation Needed for Enrollment
Low Income	YouthBuild Application
Homeless Youth	Valid State ID/Driver’s License with Champaign County address
Youth Offender	Birth Certificate
Adult Offender	Social Security Card
Disability	High School withdrawal verification
Incarcerated Parent	Official Transcripts OR High School Diploma
Migrant Youth	Active Bank Account: Routing and Account Numbers
Within or Aged-Out of Foster System

Proof of Residency
- Students living with parent(s) MUST have proof of residence with a parent name and address of where parent lives.
- Students declaring, they are independent MUST HAVE BOTH proof of residence AND proof of income (paystub from current job or government assistance).
ACCEPTABLE FORMS FOR PROOF OF RESIDENCE

(All documentation must be dated with 90 days of enrollment date.)
- Illinois Driver’s License / State ID
OR TWO OF THE FOLLOWING
- Monthly Utility Bill or Receipt of Utility Installation (Electric, Water, Gas, Sewage)
- Signed Lease/Rental Agreement/Renter’s Insurance Declaration Page
- Monthly Mortgage Statement/Property Tax Bill/Homeowner’s Insurance Declaration Page
- Monthly Bank Statement
File upload

Total Files Allowed: 3. Accepted File Types: pdf, doc, docx, html, zip, jpg, jpeg, png
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Application Contact Information
For application support, submissions, or questions contact:

217-378-7100

2008 N. Market Street, Champaign IL, 61822

Upload personal statement*

Total Files Allowed: 1. Accepted File Types: pdf, doc, docx, txt, rtf, mp3, wma, mpg, avi, wav, wmv
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Acknowledgements
I have read and understand each application item thus far and certify that the information is true and accurate to the best of my knowledge. I further realize that falsified information may result in the rejection of this application and subsequent termination from services.
Applicant signature*

First NameLast Name
Parent/ Guardian signature*

First NameLast Name
Date*

MonthDayYear
Please verify that you are human*
Should be Empty:

	Yes	No	Explain
Do you live alone?
Do you live with parents/ guardians?
Do you have any dependents?
If you have dependents, how many?
Do you live with children? (siblings, nieces, nephews, ect.)
Do you live with your own child/ children?
Do you (or any members of your household) receive public assistance?
Are you a foster child OR aging out of foster care?

	Yes	No
Have you ever been arrested?
Do you currently have a case pending?
Have you ever been convicted of a misdemeanor?
Have you ever been convicted of a felony?
Have you ever been in a juvenile detention facility?
If yes, what was the length of your incarceration?
Have you ever been on probation?
Have you ever been on parole?
Have you ever lost your voting rights?

Housing Authority of Champaign County YouthBuild’s Mission…