APPLICATION: Virtual Career Readiness Program

Program Dates: October 12 - November 20, 2020

1. Your Information

First Name *This question is required.

Last Name *This question is required.

Street Address *This question is required.

City *This question is required.

Zip *This question is required.

Email Address *This question is required. This question requires a valid email address.

Parent/Guardian Email *This question is required. This question requires a valid email address.

Phone Number *This question is required.

Other Phone Number

Are you a U.S. citizen? *This question is required.

Age (You must be 16-24 years old as of Oct 1, 2020 to be eligible for the program.) *This question is required.

Date of Birth (MM/DD/YYYY) *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

2. PLEASE NOTE: If you don't have a computer or internet access, it will not affect your ability to participate in the program.

Do you have computer equipment on a regular basis to participate for six weeks (Oct 8 - Nov 20)? *This question is required.

Does your computer

Space Cell	Yes	No
have a working camera? *This question is required	have a working camera?: Yes	have a working camera?: No
have a working microphone? *This question is required	have a working microphone?: Yes	have a working microphone?: No

Do you have internet access on a regular basis to participate for six weeks (Oct 8 - Nov 20)? *This question is required.

3. Are you employed? *This question is required.

4. Number of people in your family (including you) *This question is required.

5. What is your family's YEARLY income from work? *This question is required.

6. Do you live in the city of Muskegon or Muskegon Heights?

7. Which of the statements below describe you and/or your family? Please select all that apply. *This question is required.

You receive free or reduced lunch at school
You are a foster youth or aged out of a foster youth program
Your family is eligible for public assistance: food or cash assistance (EBT or Bridgecard) or Supplemental Security Income (SSI)
You received special education classes while in school (IEP) or have any disability
You have math or reading levels below grade level
You are studying English since it’s not your first language
You have been involved with the juvenile or adult justice system
You or your family are homeless
You are a parent or pregnant

7. Which of the statements below describe your education? Please select all that apply. *This question is required.

High school graduate or completed GED
High school drop out
Currently enrolled in GED program.
Currently enrolled in high school or an alternative school
You currently are enrolled in a West Michigan Works Youth Program or JMG Program

8. How did you hear about the Virtual Career Readiness program? *This question is required.