Closing the G.A.P. Application
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  • Closing the G.A.P.

     

    Welcome to the final step in joining our B2L Direct Program Initative. At Build 2 Lead our goal is to provide quality programs that result in our participants feeling inspired, motivated, and prepared to engage in real world advocacy projects, workforce development career pathways, and build plans for college access and leadership development. This summer, we thank you for choosing to sign up for our programs and look forward to helping you "Build 2 Lead!"  

     

    Dairyona Thompson

    Program Manager

    dthompson@build2lead.org 

  • Registration Information

  • Format: 000-000-0000.
  • Parent or Guardian/Emergency Contact Info 

  • Referral Info

  • How did you hear about Build 2 Lead?*
  • Housing Status

  • Please check all that apply to your current housing situation and use the space below to describe your situation*
  • If you have secure housing how many adults are in your household?*
  • Are you currently experiencing a crisis?*
  • Health Status

  • Have you or your friends been involved in OR experienced any of the below things? (This information will only be reviewed by Build 2 Lead case management staff and is considered confidential)*
  • Current Grade/Education Level

  • Please check your current grade level*
  • Career/Job Interest

  • Workforce Development: Please choose all of the careers you are interested in.*
  • Resource Supports

  • Please pick if any supports you will need this school year:*
  • B2L Resource Connection Section

    In this section we will ask questions related to youth's/young adults involvement in the criminal justice system and struggles with any mental/behavioral health. If you below the age of 14 please move onto the next section.
  • Have you ever been convicted of a crime ?*
  • Would you like a referral for legal services (expungement, taxes, court, legal aid)?
  • Terms and Conditions

  • Please read carefully:

    The undersigned agrees to be bound by all the rules governing Build 2 Lead (B2L) and in addition agrees to the following:

     

    1. Waive any and all claims against B2L, its Board Members, employees, partners and agents for any liability or loss (including but not limited to bodily injury arising out of the programming and activities of B2L).

    2. Indemnity to hold harmless the B2L employees and agents from any and all claims, demands, liability or loss (including, but not limited to, legal expenses or court costs which may arise from or be incurred as a result of any referrals related to our workforce program "Closing the G.A.P").  

    By my electronic signature below, I agree to the B2L governing policies and the agreement above. 

  • The Undersigned Client Certifies That:*
  • Reload
  • For Staff Use Only

  •  Programs 

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  •  - -
  • Exit Information 

  •  - -
  • All required information have been reviewed and confirmed (Verified or Missing Info)
  • I confirm that all information provided in this form is accurate to the best of my knowledge (Yes or No, if no please explain)
  • This registration is complete and ready for program entry. (Yes or Pending)
  • Follow-up method used: Call, Text, Email or all three
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  • Should be Empty: