Y.A.S.S pROGRAM Application Form
Young Adults Supplemental Skills
Name
First Name
Last Name
Phone Number
E-mail
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Referral Source
Are you currently employed? If yes, please provide details.
What is your LINKEDIN account name
Are you in need of volunteer hours? If so, how many?
For what reason?
YASS Program Services
Community Services
Work Development
Business Development
CPR/ Frist Aid Certifications
In need of resources
In need of supplies for work
What days are your available?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Skillsets or Area of Interests
Do you need any essential supplies to assist you alone your volunteer or work development journey? Please check all the boxes that apply to you.
Professional attire
Winter coats to stay warm
Personal care items
Public transportation passes or gas card.
Portable phone chargers or power banks
Motivational or self-help books
Healthy Snacks
What size do you wear? Shirt:
blank
Pants:
blank
Shoes
Blank
Coat:
Blank
Are there any specific challenges or obstacles you are facing in your workforce development journey that you would like assistance with?
Comments
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Which of the following resources would you like to receive?support in, or currently stand in need of? Please check all that apply."
Driver's license study materials or resources forobtaining a driver's license
FAFSA (Free Application for Federal Student Aid) formsand assistance for college financial aid
Information on GED (General Educational Development) testing sites and study materials
First aid and CPR certification courses or workshops
Vocational training program information
Career counseling services for guidance on career paths and skill development
Networking events or mentorship opportunities with industryprofessionals
Online platforms for virtual jobs
Financial literacy resources or workshops for budgeting and financial planning.
Mental health resources and counseling services foroverall well-being
Access to affordable housing resources
Assistance with accessing healthcare and health insurance information.
Legal aid resources for addressing any legal challenges or concerns
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