2024-25 RISING STARS BUSINESS ACADEMY NEW STUDENT ENROLLMENT APPLICATION

RISING STARS BUSINESS ACADEMY ENROLLMENT APPLICATION

Photograph & Video Release Form
I hereby grant permission to the rights of my image, likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.

Photographic, audio or video recordings may be used for the following purposes:

• conference presentations

• educational presentations or courses

• infomercials and recruiting materials

• on-line educational courses

• educational videos

I will be consulted about the use of the photographs or video recording for any purpose other than those listed above. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.

By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.
Participant's Full Name*
Phone Number
Please enter a valid phone number.
Email
example@example.com
Participant's Signature*

Clear
Date*

MonthDayYear
Date
I participant is a minor under age 18, then the signature of a parent or legal guardian is also required.
Name of Parent/Guardian
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date

Welcome to Rising Stars Business Academy (RSBA). Rising Stars Business Academy is a 501©3 non-profit organization that provides mentorship, leadership development, etiquette classes, life skills, computer classes, entrepreneurship, vocational classes, job readiness, career development, business workshops, resume writing, counseling, motivational workshops, motivational speakers, college readiness, educational field trips, scholarships, extracurricular activities and much more.

Rising Stars Business Academy offers an enriching program, Moreno Valley YouthBuild (MVYB), an affiliate of YouthBuild USA. MVYB partners with YouthBuild Charter School of California for their educational services. With the unique blend of these three organizations, Moreno Valley YouthBuild can offer youth between the ages of 16-24 the opportunity to receive their WASC Accredited High School Diploma through our partner, YouthBuild Charter School of California (YCSC).

Participants must enroll in Moreno Valley YouthBuild and be accepted before enrolling into YCSC. Participants go through a formal interview process and will be informed if they are accepted into the program after completing their Mental Toughness Orientation (MTO). Participants go through mandatory workshops including, no bullying, no sexual harassment, rules & policies, team building activities, etc. (See MVYB participant handbook for detailed rules & policies). Participants who fail to adhere to the rules and policies at MVYB will jeopardize their enrollment in the program. If a participant has been self-exited from Moreno Valley YouthBuild, he/she will instantaneously be exited from YCSC.

I understand if I am accepted into Moreno Valley YouthBuild, that I will follow all rules and policies that have been put in place. I further understand that if I do not follow the rules and policies of Moreno Valley YouthBuild, that I may be exited or placed on probation from the program until further notice.
Participant's Name*
Participant's Signature*

Clear
Date

MonthDayYear
Date
Parent/Guardian Signature (for minors under 18 years old)

Clear

2023-2024 Intake Application Form
Shirt Size:*
Age:*
Date*

MonthDayYear
Date
Participant Information
Name*

First NameMiddle NameLast Name
Physical Address*

Street Address

Apartment

CityState / Province

Postal / Zip Code
Is this permanent housing?*

YesNo
If no, please briefly describe what type of temporary housing your physical address represents:
Email*
example@example.com
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Birthdate*

MonthDayYear
Date
Birth City:*
Birth State:*
Birth Country*
Gender*

MaleFemaleNon-Binary

Additional Participant Information
Are you physically capable to participate in all physical activities?*

YesNo
If no, explain:
Are you currently on any medication?*

YesNo
If yes, please specify:
Do you currently or have you ever had any special health conditions (for example: asthma, seizures, hearing impaired, etc.?)*

YesNo
If yes, please explain:

Records Release Form
My Name:
Age
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I give permission to Rising Stars Business Academy to release my participant information to the individuals listed below. Information released may include program attendance records, discipline reports, special programs, and any other information that pertains to my progress.
Name of Individual 1
Relationship to Individual 1 (mother, father, guardian, aunt, etc.)
Name of Individual 2
Relationship to Individual 2
Name of Individual 3
Relationship to Individual 3
I am the person named above and I am 18 years of age or older

Clear
Date

MonthDayYear
Date
Security Search

As a reminder, all participants will be wanded when entering the RSBA building. All participants will be asked to open all bags (backpacks, purses, lunch bags, etc.) for search. If any weapons, contraband, drugs, or alcohol are found on the person of any participant, it will be confiscated by a RSBA director. Thereafter, parents and or police will be contacted. Participants are not allowed to bring any contraband or weapons onto campus at any time.
I,type name here*, understand and acknowledge the security search and will abide by all RSBA rules. I too understand that by not following the rules and policies, I am at risk of being self-exited from the program.
Student Signature

Clear
Date

MonthDayYear
Date

Self-Certification Statement
I certify under penalty of perjury that the above information is complete and accurate to the best of my knowledge. I understand that Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony and assistance can be terminated for knowingly and willingly making a false or fraudulent statement to a department of the United States Government. I agree to provide any additional documentation required by the program administer to document my/our household income.
For students ages 18+

I am the person named in this application and am 18 years of age or older.
Adult student full name:
Adult Student Signature

Clear
Date

MonthDayYear
Date
For students ages 16-17

I am the parent/guardian for the minor person named in this application.
Parent/Guardian Full Name
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date

Participant Survey Questions: Part II

Instructions: The following questions are not yes or no questions, therefore we will need you to think about the question and answer as honest as you can. Please do not leave any field blank. We will make every effort to meet your needs.
Favorite Color(s):*
What languages do you speak?*
What are your hobbies?*
What are you good at?*
Describe you personality:*
What did you not like about the classes/teachers that you have had in the past?*
What would make school classes more interesting to you?*
Where are a few places/state/countries you would like to visit?*
Have you ever thought about owning your own business some day?*

YesNo
If so, what kind of business would you like to have?*
What are your strengths?*
What would be something that you would like to improve about yourself?*
What career would you like to go into?*
What motivates you?*
Would you consider yourself a leader?*
Why or why not?*
Why have you not completed your high school diploma?*
What subject(s) do you feel you need the most help in?*
If our program was to take a trip, where would you like to go?*
Do you have any other interests?*
How will you get back and forth to school?*
What sports do you like?*
What challenges are you facing right now?*
Are you happy with yourself?*

YesNo
Please explain your answer:*
What would you like to share about yourself that we should know:*
Are you willing to give Moreno Valley YouthBuild your best efforts toward helping yourself to achieving your educational goals?*
From the little that you know about RSBA/MVYB, what has sparked your interest to enroll?*
How did you hear about RSBA/MVYB?*
Who referred you?*
Do you know any participants at RSBA/MVYB?*

YesNo
If yes, who?
Rising Stars Business Academy/ Moreno Valley YouthBuild is here for you.

Thank you!

We look forward to seeing you soon!
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RISING STARS BUSINESS ACADEMY ENROLLMENT APPLICATION

Photograph & Video Release Form

2023-2024 Intake Application Form

Participant Information

Parent/Guardian Information

Additional Participant Information

Previous School Information

Home Language Survey

Special Education Services

Probation

Race and Ethnicity Survey

Voter:

YouthBuild Questions:

Records Release Form

Self-Certification Statement

For students ages 18+

For students ages 16-17

Participant Survey Questions: Part I

Participant Survey Questions: Part II