CSRA Youth Interest Form
The WIOA Youth Program provides training, education, supportive services, and work experience opportunities to help young people prepare for future careers. We serve out-of-school youth ages 16–24 who face barriers to education or employment. Barriers may include being a high school dropout, pregnant or parenting, having a documented disability, involvement in foster care (with supporting documentation), homelessness, justice system involvement (with proof), receiving public assistance, or other challenges that create a need for additional support and career development services. Our program serves participants throughout nine counties in the CSRA area: Richmond, Columbia, Burke, Jenkins, Jefferson, McDuffie, Lincoln, Washington, and Wilkes counties.
Date
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
How old are you?
Are you enrolled in high school?
Yes, I am enrolled in high school
I graduated from high school
I did not graduate high school
I am enrolled in college or a technical program
I am enrolled in GED classes.
I am not enrolled in high school or any program
Does any of the following circumstances apply to you?
I am a Parent (mother, father, or currently pregnant).
I am receiving public assistance (SNAP, TANF).)
I am currently or was formerly in foster care.
I am currently experiencing homelessness.
I have a disability.
I have a history of arrest or involvement with the juvenile justice system.
None of these apply.
What county do you live in?
Burke
Columbia
Jefferson
Jenkins
Jefferson
McDuffie
Richmond
Washington
Wilkes
Hancock
What is your preferrred method of contact?
Phone call
Text message
Email
Other________________________
Do you currently work?
Yes, I work full-time
Yes, I work part-time
No, I have never worked
No, I am not currently working but have held a job before
What are you interest in
I am interested in Work Experience opportunities such as customer service, food service, maintenance, childcare, warehouse, and related fields.
I am interested in Work Readiness Training, which includes job-seeking skills, résumé writing, professional communication, financial literacy, time management, and career exploration.
I am interested in credential training opportunities such as GED preparation, apprenticeships, or short-term certificates (e.g., Welding, CNA, Forklift, OSHA, etc.).
I am not sure at this time and would like assistance in choosing the best option.
Submit
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