Inspire Youth Development Program

Inspire Youth Development Program

Program for 17-25 year old. This program is for those who are entering the workforce for the first time.
Student Name *

Prefix First Name Last Name
Student Date of Birth

Month Day Year
Date
Student Current Age
Gender
Ethnicity (please check one)
Parent Name *

Prefix First Name Last Name

Student Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Are you a legal citizen of the United States?

Yes No
Student Phone Number *

Area Code Phone Number
Student E-mail *
Parent Phone Number *

Area Code Phone Number
Parent E-mail *
example@example.com
Is youth currently enrolled in high school

Yes No
If you selected "YES" what school does he/she attend and current grade level?
Select ALL that apply:

High School Graduate GED Recipient Currently Enrolled in GED or Drop-out Recovery Program Currently Not Enrolled/High School Drop Out
Is/Has youth received special education accommodations? Please select all that apply:
Is there anything else needed to share about youth education plan/services
All Students must have reliable transportation

Agree
For the student: This program meets Monday-Thursday 3:00 PM-6:00 PM. Students cannot miss any days. This will warrant dismissal from the program. Do you understand?

Yes No
For the Student: Tell us a little about yourself (School you attend, hobbies, favorite movies, activities, etc.)
For the Student: Why do you want to join Inspire Youth Development Program?
For the student: Have you ever worked before?

Yes No
For the Student: Do you know what type of job/career you are interested in?
For the Parent: What do you want your child to gain out of the program?
Emergency Contact

First Name Last Name
Emergency Contact Phone Number

Area Code Phone Number
Emergency Contact Email
example@example.com
Workforce Development Topics Covered:
- Communication and Technology
- FDIC Money Smart
- Safety in the Workplace
- First Impressions & Customer Service
- Skills Analysis
- Career Portfolio: Resume and Cover Letter
- Job Application Process
- Dress 4 Success & The Interview Process: Before, During, and After the Interview
- Job Search Techniques & Job Commitment
- Life and Career Development Planning
Please submit last report card/progress report

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Please submit medical insurance card

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Signature

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