Y.E.S. FORWARD INTEREST FORM
Youth Engagement Services Older Youth Program
Thank you for your interest in the Y.E.S. Forward Program!
Y.E.S. Forward supports Richmond-area young adults (ages 18–24) in exploring career pathways in high-demand fields like healthcare, skilled trades, and technology. Build skills, boost your earning potential, and take the next step forward—with a team ready to support your journey.
Personal Information
Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
Date
Are you between 18-24 years old?
*
Yes
No
City of Richmond Resident?
*
Please Select
Yes
No
Are you a City of Richmond resident?
*
Yes
No
Are you currently enrolled in school or employed?
*
Yes - in school only
Yes - working only
Yes - both in school and working
No
Age
*
Contact Information
Preferred Contact Method
*
Phone Call
Text
Email
Phone Number
*
E-mail
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Back
Next
Career & Program Interest
We want to get to know you. Please answer the following questions.
How did you hear about Youth Engagement Services (Y.E.S.) Forward program?
*
Please Select
Social Media
Friend/Family
Referral
Website
Staff Member
Event or Flyer
Which of the following career paths are you most interested in? (Select all that apply):
*
Healthcare (Clinical medical assistant, pharmacy technician, nursing, etc.)
Information Technology (IT support, coding, cybersecurity)
Skilled Trades (construction, HVAC, electrical, plumbing)
Advanced Manufacturing & Logistics
Human Services (social work, school-based support, community health, youth/family outreach)
Other
Which of the following would help you most right now? (Select all that apply)
*
Help figuring out what career I want
Help enrolling in a training or certification program
Support enrolling in school or college
Resume building or job search assistance
Interview practice or professional communication skills support
I feel ready and would like help finding a job
Other
Have you earned a high school diploma or GED?
*
Yes
No
Currently working on it
Have you had any previous work experience (paid, unpaid, or volunteer)?
*
Yes
No
Would you be interested in learning more about building your financial future? (Check all that apply)
*
Budgeting
Credit & Loans
Opening a bank account
Saving & investing
Entrepreneurship
How ready do you feel to enter the workforce?
*
Not Ready
1
2
3
4
Very Ready
5
1 is Not Ready, 5 is Very Ready
What would help you feel more prepared for work? (Select all that apply)
Resume writing & interview skills
Learning how to communicate with others (ex: supervisors/co-workers)
Understanding workplace expectations & professionalism
Managing time & balancing work responsibilities
Hands-on experience before starting a job
Financial Literacy (Budgeting, Understanding Paychecks, Savings)
Digital & Tech Skills (Email, Software, Spreadsheets)
Other
Which skills would you like to develop further to feel more prepared for work?
Communication
Time Management & Organization
Problem-solving & Critical Thinking
Resume Writing & Interview Prep
Leadership & Teamwork
Customer Service & Relationship Building
Digital & Tech Skills (Email, Spreadsheets, Software)
Financial Literacy (Budgeting, Understanding Paychecks, Savings)
Other
What would help you feel more prepared for work?
*
Did you graduate from high school?
Please Select
Yes
No
Do you have previous work experience?
Please Select
Yes
No
Are you currently working or in school?
*
Please Select
Yes
No
Have you previously participated in Youth Engagement Services programming?
*
Please Select
Yes
No
Work Experience
Are you currently employed?
*
Yes
No
What are your short-term and long-term career goals?
*
What do you hope to gain from Y.E.S. Forward Program?
Job Training Opportunities
Earning Certifications/Credentials
Paid Work Experience
Career Development Sessions
Mentorship
Other
Have you received any formal training or certifications related to your desired career field?
*
Yes
No
This program will be hybrid (in-person and virtual attendance requirements). Do you have the ability to meet in-person up to 3 times for about 4 hours?
*
Yes
No
Do you know about jobs available in the career field you're interested in?
*
Yes
No
Do you have access to reliable internet?
Yes
No
Barriers & Availability
What challenges or barriers (if any) may impact your ability to complete training or work at this time? (Select all that apply)
*
Transportation
Access to internet or devices
Childcare
Housing (No stable housing)
Legal Challenges
None at this time
Other
What is your primary mode of transportation?
*
Personal Vehicle
GRTC Bus
Lyft/Uber
Walking
Rely on family/friends for rides
Other
What is your preferred language for communication?
*
Please Select
English
Spanish
Other
Do you need language support for program participation? (Select one)
*
No, I am comfortable communicating in English.
Yes, I prefer receiving materials and support in Spanish.
Yes, I need support in another language.
Other
This program lasts up to 16 weeks, combining career training and paid work experience. Are you available to participate?
*
Yes
No
Need More Information
Do you have stable housing?
*
Yes
No
Do you have reliable transportation to attend training and work placement?
*
Yes
No
Sometimes
Please indicate which times of the day you are available to participate in the program. (Select all that apply)
*
Morning
Mid-day
Evening
What challenges or barriers may impact your ability to fully participate or complete training?
Please Select
Transportation
Childcare/family related
Work Schedule
Other
Personal Motivation
The next few questions will ask for a response based on a 1-5 scale. 1= least likely or least willing and 5= most likely or most willing
If currently unemployed, what's tough about finding a job for you?
What do you think are your strengths and weaknesses in a professional setting?
*
The primary goal of this program is to help individuals establish a career beyond their participation in the program. On a scale from 1-5, how likely are you to take advantage of 12 weeks of paid work opportunities?
*
Least likely
1
2
3
4
Most Likely
5
1 is Least likely, 5 is Most Likely
On a scale from 1-5, how likely are you to take advantage of up to 12 weeks of training and education programs that lead to career advancement?
*
Least likely
1
2
3
4
Most likely
5
1 is Least likely, 5 is Most likely
Being in a professional work environment can be challenging sometimes whether that be working with customers, teammates, supervisors, or difficult projects. On a scale from 1-5, how willing are you to put forth the effort necessary to grow as a professional?
*
Least likely
1
2
3
4
Most likely
5
1 is Least likely, 5 is Most likely
Choosing a career and working towards long term goals can be challenging sometimes. On a scale from 1-5, how willing are you to put forth the effort necessary to achieve your goals?
*
Least likely
1
2
3
4
Most likely
5
1 is Least likely, 5 is Most likely
On a scale from 1-5, how willing are you to get out of your comfort zone to try or experience new things?
*
Least likely
1
2
3
4
Most likely
5
1 is Least likely, 5 is Most likely
Back
Next
What's the best way to reach you to discuss next steps?
*
Call
Text
Email
Any other details you'd like to share? (Optional)
Submit
Should be Empty: