• RISING STARS BUSINESS ACADEMY ENROLLMENT APPLICATION

    RISING STARS BUSINESS ACADEMY ENROLLMENT APPLICATION

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  • Photograph & Video Release Form

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    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.

  • Format: (000) 000-0000.
  • Date*
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  • I participant is a minor under age 18, then the signature of a parent or legal guardian is also required.

  • Date
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  • 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.

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  • 2025-2026 Intake Application Form

  • Date*
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  • Participant Information

  • Is this permanent housing?*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Birthdate*
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  • Gender*

  • Parent/Guardian Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Does your child live with you?
  • Parent/Guardian 1's Highest Level of Education
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Does child live with Parent/Guardian 2?
  • Parent/Guardian 2's Highest Level of Education:

  • Additional Participant Information

  • Are you physically capable to participate in all physical activities?*
  • Are you currently on any medication?*
  • Do you currently or have you ever had any special health conditions (for example: asthma, seizures, hearing impaired, etc.?)*

  • Previous School Information

  • List the previous high schools you attended, starting with the one you most recently attended.

  • Home Language Survey

  • Have you ever been enrolled in a bilingual program?*
  • Are you currently an English learner?*

  • Special Education Services

  • Have you ever been in a Special Education Program?*
  • Were you in a Special Education Program in the last school you attended?*
  • Do you have an active IEP (Individualized Education Plan)?*
  • Have you ever been part of a 504 Plan?*

  • Probation

  • Are you currently on probation or parole?*
  • Format: (000) 000-0000.
  • Check any that apply:*

  • Race and Ethnicity Survey

    New federal race and ethnicity data collection/reporting requirements beginning in 2009-2010 require all participants to identify their ethnicity from the two categories below.
  • Are you Hispanic or Latino?*
  • Race: No matter what ethnicity is selected above, at least one race must also be selected below:*

  • Voter:

  • Are you registered to vote*
  • Are you eligible to register to vote?*

  • YouthBuild Questions:

  • Are you in foster care?*
  • Have you ever been in foster care?*
  • Have you ever been homeless?*
  • Are you LGBTQ?*
  • Are you a parent?*
  • Marital Status*
  • Post-secondary Goals*

  • Records Release Form

  • Date of Birth
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  • 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.

  • Date
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  • 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,*, 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.

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  • 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.
  • Date
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  • For students ages 16-17

    I am the parent/guardian for the minor person named in this application.
  • Date
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  • Participant Survey Questions: Part I

    Instructions: Please read the questions, then mark either yes or no. Some questions will need additional work. Please fill out as completely as possible. Take your time to answer the questions below truthfully. In the end, the answers should reflect you.
  • Do you sing?*
  • Do you dance?*
  • Do you like to write?*
  • Do you like to read?*
  • Do you know how to make a PowerPoint?*
  • Do you know how to create brochures and flyers?*
  • Do you like art?*
  • Do you like to paint?*
  • Do you like to draw?*
  • Do you get bored easily?*
  • Do you smoke?*
  • Do you drink?*
  • Do you like animals?*
  • Do you like to fix things?*
  • Do you like to work on cars?*
  • Do you have a car?*
  • Do you like to do hair?*
  • Do you like photography?*
  • Do you have an attitude problem?*
  • Do you work well with others?*
  • Do you feel that it is important to get your High School Diploma?*
  • Are you easily distracted?*
  • Are you interested in acting/drama?*
  • Can you play any instruments?*
  • Would you like to go to college?*
  • Are you interested in the Military?*
  • Are you a creative person?*
  • Can you work video/sound system equipment?*
  • Are you shy?*
  • Are you interested in traveling?*
  • Are you interested in construction?*
  • Can you work on a computer?*
  • Are you late?*
  • Do you have children?*
  • Do you have a role model?*
  • Are you outspoken?*

  • 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.
  • Have you ever thought about owning your own business some day?*
  • Are you happy with yourself?*
  • Do you know any participants at RSBA/MVYB?*
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  • Rising Stars Business Academy/ Moreno Valley YouthBuild is here for you.

    Thank you!

    We look forward to seeing you soon!

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