Studio 4 LA Membership Application
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  • Studio 4 LA Membership Application

    To apply to Studio 4 LA, please complete all questions below. The application will take approximately 15-30 minutes to complete. You can save your responses and complete later if you are not able to complete the entire application in one sitting.
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  • Format: (000) 000-0000.
  • Which of the following are you interested in (check all that apply):*

  • Background and Personal Information

  • Please note: Your answers to the following questions will not affect whether or not you are accepted into the program. They are for our internal data collection use only.

  • Race/Ethnicity (check any that apply)*
  • Marital Status*
  • Do you have any children?*
  • If you have children, do they live at home with you? (If you don't have children, please skip.)
  • If you have children, do you pay child support? (If you don't have children, please skip.)
  • Are you a United States Citizen?*
  • Are you authorized to work in the U.S.?*
  • Do you have a valid driver's license?*
  • Are you registered to vote?*
  • If you are a male ages 18+, have you registered with Selective Services?
  • What is your current living situation? (Check any that apply.)*
  • Have you ever been in foster care?*
  • Have you ever been convicted of a crime? (Please answer honestly. Answering “yes” will NOT hurt your chances of being selected for various programs)*
  • Do you have any active court cases?*
  • Are you on probation and/or parole?*
  • Are you receiving any financial benefits such as food assistance, subsidizing housing or others?*
  • Do you have any barriers (reliable transportation, a need for childcare, etc.) that could make it hard for you to attend the program on time every day? (Please note that depending on the barrier, Studio 4 LA may be able to provide or refer you to the support you need.)*

  • Educational Background/Information

  • Have you ever received Special Education services?*
  • Have you ever had an IEP or 504 Plan?*
  • Are you currently enrolled in a GED program or other school?*

  • Personal Statement

  • Our program includes a variety of learning activities. Do you agrees to participate in all activities inside and outside the classroom?*

  • Emergency Contact Information

    Please list two individuals we can reach in case of an emergency, and be sure to let them know you have listed them. Include cell and home phone numbers.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Certification and Signature

  • I hereby certify that the information in this application is true and correct to the best of my knowledge. I also authorize Studio 4 LA staff to verify this information when reviewing my eligibility for the program. I understand that I may be asked to provide documentation and agree to sign, if asked, one or more release forms to allow Studio 4 LA to verify the information provided in this application.

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