Isaacs Education and Workforce Enrollment Form (updated)

Your Journey Begins Here!

Thank you for choosing to develop your employment and education skills at the Isaacs Center. We are happy that you have begun the process of joining our program.

The mission of the Education and Workforce program is to prepare you for success and self-sufficiency by creating learning opportunities, connecting youth to resources, and providing individualized support.

We hope to empower you to accomplish your employment, educational, and personal goals. This program is more than an employment & education program; in addition to your professional development, we will work with you to develop critical life skills that enhance your personal well-being, personal responsibility, confidence and decision- making skills.

Through this process we hope you learn to trust us, but more importantly trust yourself, as you begin these important next steps.
Your Full Legal Name*

Legal First NameLegal Last Name
Preferred Name

Preferred First NamePreferred Last Name
Application ID*
This can be found in the email confirmation from your program interest form. Reach out to EWinfo@isaacscenter.org if you need this.
Please tell us what joining this program means to you and for your future?*
What additional services are you interested in receiving? Check all that apply.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Social Security Number*
Follow the format
Gender Identity*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Appartment Number
Yes
What is the name of the development?
Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
Home Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Ethnicity*
AsianBlack or African AmericanLatino/aAmerican Indian/Alaskan NativeOtherNative Hawaiian/Pacific IslanderWhite (not Latino/a)No Response
YesNo
YesNo
What languages do you speak?*
Country of Origin*
Emergency Contacts

Please provide us with the names and contact information of the people we should contact in the event of an emergency.
Emergency Contact First and Last Name*
Emergency Contact Relationship*
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
2nd Emergency Contact First and Last Name*
2nd Emergency Contact Relationship*
2nd Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Highest Grade Completed*
Most Recent School Attended*
Major
Attendance Start Date

MonthDayYear
Date
Attendance End Date

MonthDayYear
Date
Most Recent Employer*
Most Recent Employment Start Date*

MonthDayYear
Date
Most Recent Employment End Date

MonthDayYear
Date
Hourly Wage (USD)*
I, the undersigned, of legal age OR the parent/guardian of the undersigned, consent to the use and reproduction of any photographs, film and/or video taken by or on behalf of the Stanley M. Isaacs Neighborhood Center, Inc./Goddard Riverside I understand that this media may be used to promote the Stanley M. Isaacs Neighborhood Center, Inc./Goddard Riverside. As such, I consent to the use of my name, portrait or photograph by the Isaacs Center for advertising, educational use, publicity use, and trade purposes, in any/all media, including but not limited to television, radio, and publications—print and digital.*

YesNo
Applicant Signature*

Clear
Date*

MonthDayYear
Date
Parent Signature

Clear
Date

MonthDayYear
Date
To the best of my knowledge the information above is true. I agree to its verification and understand that falsification may be grounds for termination of service. Information provided may be used by the agency for reporting data and to city of New York to improve city services or to access additional funding.
Participant Signature*

Clear
Date*

MonthDayYear
Date
Parent/Guardian Acknowledgement
YesNo
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
Please upload CLEAR copies of the documents below.

If you have any issues uploading OR do not have access to the requested documents, please ask an Education and Workforce team member for support or email us at EWINFO@isaacscenter.org.
Photo ID - Please upload a clear copy of one of the following: State ID | Passport | School ID | ID NYC*

Cancelof
Please upload a clear copy of your birth certificate.*

Cancelof
Please upload your proof of address MUST BE DATED WITHIN THE LAST SIX MONTHS. DATE MUST BE VISIBLE: Utility Bill | Current Lease | Cable Bill w Phone Service Listed | Cell Bill with Address Visible | Official Mail from a Federal, State, or City Agency*

Cancelof
Please upload your proof of vaccination

Cancelof
Please upload a copy of your social security card.*

Cancelof
Please upload your resume.*

Cancelof
Please upload your high school diploma.*

Cancelof
Should be Empty:

Emergency Contacts

Parent/Guardian Acknowledgement