YouthBuild: Rockville Housing Enterprises Application
YouthBuild: Rockville Housing Enterprises offers community-based pre-apprenticeship and registered apprenticeship programs that provide job training and educational opportunities for at-risk youth ages 16-24 who have previously dropped out of high school. Participants learn vocational skills and obtain an industry recognized credential in construction. Participants also provide community service through the required construction or rehabilitation of affordable housing for low-income or homeless families in their own neighborhoods. Participants split their time between the vocational training work site and the classroom, where they earn their high school equivalency, learn to be community leaders, and prepare for postsecondary training opportunities, including college, apprenticeships, and employment. YouthBuild: Rockville Housing Enterprises includes significant support systems, such as leadership development, networking, follow-up education, employment, and personal counseling services; additionally, participants participate in community service and service learning projects.
Identifying Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What Maryland County are you a resident of?
*
Back
Next
Personal Characteristics
Gender
*
Male
Female
Non-Binary
Date of Birth
*
-
Month
-
Day
Year
Date
Your Current Age
*
Bilingual
*
Yes
No
U.S. Citizen
*
Yes
No
Marital Status
*
Single
Married
Divorced
Separated
Widowed
Type of Housing
*
Public Housing
House/Apartment
Homeless
Homeless Shelter
Halfway House
Group Home
Other
Annual Household Income
*
Ethnicity
*
Asian America/ Pacific Islander
Black/ African American
Hispanic/ Latin American
Native American
Caucasian
Multiracial
Do you require accessibility/disability supports?
*
Yes
No
If yes, please explain supports required if selected for YouthBuild:
Are you and can provide proof that you are enrolled in Selective Service?
*
Yes
No
Personal History
Highest Grade Completed
*
Do you have your GED?
*
If yes, date received
Do you have your high school diploma?
*
Yes
No
Are you currently in school?
*
Yes
No
If Yes, what institution?
Current Employment Status
*
Employed: Full Time
Employed: Part Time
Unemployed: Looking
Unemployed: Not Looking
Other
Dependence and Public Assistance
Do you live by yourself?
*
Yes
No
Do you live with your parents (Mother, Father, or both)
*
Yes
No
Do you have any dependents?
*
Yes
No
If you have dependents, how many do you have?
Will you need child care assistance?
*
Yes
No
Do you receive child support?
*
Yes
No
Do you pay child support?
*
Yes
No
Do you live with children? (Brothers, sisters, nieces, nephews, etc.)
*
Yes
No
Do you live with your own child or children?
*
Yes
No
Do you receive public assistance? (Food stamps, WIC, TANA, EIC etc)
*
Yes
No
Does anyone you live with receive public assistance?
*
Yes
No
Are you a foster child?
*
Yes
No
Were you a foster child who aged-out of foster care?
*
Yes
No
Criminal Justice History
Please answer the following questions honestly
Have you ever been arrested?
*
Yes
No
Do you currently have a case pending?
*
Yes
No
Have you ever been convicted of a misdemeanor?
*
Yes
No
Have you ever been convicted of felony?
*
Yes
No
Have you ever been in a juvenile detention facility?
*
Yes
No
Have you ever been in an adult correctional facility?
*
Yes
No
Have you ever been on probation?
*
Yes
No
Are you currently on probation?
*
Yes
No
Have you ever been on parole?
*
Yes
No
Are you currently on parole?
*
Yes
No
Substance Abuse History
Do you have a history of alcohol abuse?
*
Yes
No
If yes, are you currently undergoing substance abuse treatment?
Have you ever had substance abuse training for the listed above?
Yes
No
Are you currently using any of the following substances?
Marijuana
*
Yes
No
Cocaine
*
Yes
No
Heroin
*
Yes
No
Other illegal substances
*
Yes
No
If Yes to any of the above substances, are you currently undergoing substance abuse treatment
Yes
No
Have you ever had substance abuse treatment for the listed above?
*
Yes
No
Commitment
Are you willing to commit to a full-time 9-month program (8:30 am – 3:30 pm)?
*
Yes
No
Maybe
Unsure
Are you willing to participate in community service?
*
Yes
No
Maybe
Unsure
Which vocational training are you interested in?
Construction
Maintenance Training & Building Operation
How did you find out about the YouthBuild program?
*
Flyer
Online Search
Current Participant
Graduate of program
Referral
Submit
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