2024 SYEP Application

Thank you so much for your interest in the Isaacs Center's Community Health and Wellness Summer Youth Employment Program (SYEP)!

We have a total of 50 spots that will be given on a first-come, first-served basis. Everyone, even prior SYEP'ers, will need to complete the application.

Participants will need to commit to an orientation before being officially accepted into the program.

Once you have completed the application, we will send you a confirmation email & text that includes your unique Application ID Number. You will use this number to upload requested documents into the SYEP Document Upload system, which we will provide instructions for. Please see the graphic at the end of this application that details the documents we'll be collecting this year.

Applications and documents are due on March 15th, 2024.

After this date, incomplete applications will be waitlisted and waitlisted applications will be given priority.
General Information
Name*

First NameMiddle Name InitialLast Name
Social Security Number*
Date of Birth*

MonthDayYear
Date
Please select your preferred Gender Identity:*

MaleFemaleTransgender FemaleGender Variant/ Non-ConformingNot ListedPrefer Not to Say
Please select your preferred Gender Pronoun:*

She/Her/HersHe/Him/HisThey/Them/TheirsPrefer Not to SayOther
Please select your Sexual Orientation:*

Heterosexual (Straight)AsexualBisexualGayLesbianPansexualQueerQuestioningNot SureOtherDecline to AnswerOther
Work Authorization*

Not Applicable (U.S. Citizen)Applicable (USCIS Document Available)Other
Selective Service Registration:*

ApplicableNot Applicable
Selective Service Registration (Please Note: Males 18 years of age and older must be registered with the Selective Service System to participate in the program.):*

YesNo
Do you live in a NYCHA Development?*

YesNo
What is your Selective Service Registration number?*
What is the name of your NYCHA Development*
Zip Code*
Street Address*
Apartment #*
Borough/ City*
State*
CONTACT INFORMATION
Parent or Legal Guardian First and Last Name*
Home Phone Number:*
Please enter a valid phone number.
Cell Phone Number*
Please select ‘Yes’ if you wouldlike to receive text updates:*

YesNo
Emergency Contact Number*
Personal Email Address*
Please provide a professional email that is not provided by your school or other professional organization
Secondary Email Address*
Please provide an alternative email that we can reach out to in case there is an issue with your primary email.
EEO Questionnaire & Other Information
Please Select Your Race*

American Indian/Alaskan NativeAsianBlack/African AmericanNative Hawaiian/ Other Pacific IslanderWhite/ CaucasianOther
How well do you speak English?*

Fluent/ Very WellWellNot WellNot Well at all
What other language(s) are you comfortable speaking?*
Education Information:
Education Status*

Full-time StudentPart-Time StudentNot-in-School
What type of school did you attend?*

CUNYDOESUNYCharterOther
Current/Last Grade Completed*
OSIS/ School ID*
Current Work Status*

Employed Full-timeEmployed Part-TimeRetiredUnemployed (Short-term, 6 months or less)Unemployed (Long-term, more than 6 months)Unemployed (Not in Labor Force)Migrant Seasonal Farm Worker
Are you currently receiving public assistance?*

YesNo
The applicant lives in a household that is headed by:*

Single Person- No ChildrenSingle Parent- FemaleSingle Parent- MaleTwo Parent HouseholdTwo Adults- No ChildrenOther
Number of family members currently living in your household*
Do you have health insurance?*

YesNo
If yes, please select the health insurance you have*

MedicaidMedicareDirect-PurchaseEmployment-BasedState Children’s Health InsuranceState Children’s Health Insurance for AdultsMilitary Health CareDecline to Answer
If no, would you like to becontacted about signing up for public health insurance?*

YesNo
Do you have previous work experience?*

YesNo
Do you have a bank account?*

YesNo
Are you interested in opening a savings account?*

YesNo
Would you like to be paid through Direct Deposit?*

YesNo

Please answer the following:*

	Yes	No
Do you have a disability?
Are you currently a runaway?
Are you currently homeless?
Are you receiving ACS Preventative Services?
Are you an offender or court involved?
Have you served in the military?
Are you a parent?
Are you a current DOE D-79 student?
Do you have an Individualized Education Program (IEP)?
Are you a member of the Business LINK (HRA Cash Assistance Program)?
Are you a Gender Based/ Domestic Violence?
Are you receiving ACS Preventative Services?

Please check off three (3) career goals (Section 1)*

AdvertisingArchitectureArts & CultureBusiness & Financial ServicesChildcareCommunications & BroadcastingComputer ScienceConservation & Environmental JusticeConstructionEducationEngineering
Section 2*

EntrepreneurshipMedia & EntertainmentFashion DesignNon-ProfitGraphic DesignPhilanthropyHealthcare/ MedicalPoliticsHospitality ManagementPsychology/ CounselingHuman ResourcesPublic ServiceInformation TechnologyReal EstateLaw EnforcementRetailLegal ServicesScience & MathematicsManagementSportsManufacturingTranportationMarketing & SalesOther
Do you have access to an electronic device with internet accessibility?*

YesNo
How did you hear about us?*
SYEP Pride gives LGBTQ+ youth ages 14-24 a unique opportunity to explore their career interest and gain job experience in a supportive environment. Participants will be able to take part in trainings and special events that inspire, educate, and open doors to networking opportunities. If selected for SYEP 2024, would you like to participate in SYEP Pride?*

YesNo
CERTIFICATION OF ACCURACY
I, the undersigned, certify that all the information on this form is true and correct. I understand that my statements are subject to verification. I further understand that any false statements may subject me to criminal prosecution under both New York State Penal Laws, section 175.35 and Federal Law, 18 U.S.C.A. 1001, and to civil action for return of all monies received. I agree and accept that I will abide by all applicable rules and regulations of this program.
Applicant Signature*
Date*

MonthDayYear
Date
Parent/ Guardian Signature*
Date*

MonthDayYear
Date
Should be Empty:

General Information

CONTACT INFORMATION

EEO Questionnaire & Other Information

Education Information:

CERTIFICATION OF ACCURACY