UCC: Program Application

UCC: Program Application
Thank you for your interest in the Urban Conservation Corps, a program of Blueprint502. This program is for young adults, 18-24 years old, who already have their High School Diploma or GED.
Contact Information
Name

First NameLast Name
Age (Program: 18-24)
Age
Date of Birth:

MonthDayYear
Date
Phone Number:

Area CodePhone Number
E-mail Address:
Your Email Address
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Education
High School Attended
High School Diploma Status
Graduation Date

MonthDayYear
Date
Interest & Experience
Have you ever participated in any environmental, conservation, or community service programs?
Note: Some classes are held at JCTC Southwest Campus
If 'YES", please describe experience below:
What skills, talents or strengths would you bring to the program?
Do you enjoy working outdoors?
Why are you interested in joining the Urban Conservation Corps?
What types of activities interest you the most? (Check all that apply)

Other
What are your career goals after this program?
What motivates you to show up and do your best each day?
Work Commitment
Are you available to work 30 hours per week?
Do you have any conflicts or obligations that might interfere with your weekly schedule?
Do you have any medical conditions or physical limitations that might affect your ability to join UCC?
Is there anything else you would like us to know about you?
I was referred to this program by:
How did you learn about this program?
RELEASES
MEDIA RELEASE: Photos/ Videos are taken of the program throughout the year and may include you directly or indirectly. These photos/ videos may be published through our website, social media, news bulletins, advertising and other media. Please indicate your consent and release of your image/ likeness to be used without notice and additional permission.
NEXT STEPS:

Your application will be reviewed and you will be contacted by a member of our team through email. Please watch your email closely.

You will be expected to bring the following documents with you to the initial interview. Get these documents ready to be fully prepared!

1) Social Security Card

2) Birth Certificate

Once these documents have been provided, you will be scheduled to take a TABE Test (academic assessment test), Drug Test and complete a Background Check.

I certify that the information provided in this application is true and complete to the best of my knowledge.

Your initials below signify that you understand and agree to this process.

Agreement & Signature
Initials:
Date

MonthDayYear
Date
Should be Empty:

UCC: Program Application

Contact Information

Education

Interest & Experience

Work Commitment

RELEASES