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Contact & Eligibility Form
Are you currently in high school or a postsecondary program (college, university, or technical program)?
*
select one
Yes
No
School's Name
When did/will you graduate from high school?
How did you hear about our program?
Contact Information
Name
*
First Name
Last Name
Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Email
Verify Email
Alternate Email
Verify Email
Phone
Alternate Phone
Do you wish to receive text message updates?
select one
Yes
No
Name
*
First Name
Last Name
Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Email
Verify Email
Phone
Do you wish to receive text message updates?
select one
Yes
No
Eligibility
General Criteria
*
Select all options that are true for you
I have proof of eligibility to work (Social Security Card, Birth Certificate, Green Card)
I have a photo ID (Driver's license, State of WA ID, or Passport)
I am between 16 and 24 years of age
I have registered with Selective Service as required (males over the age of 18 only)
I am not currently enrolled in hig h school or receiving college credit
I am a Pierce County resident
What barriers prevent you from securing or holding employment?
*
Only one area is needed to be eligible for this program
I have a criminal background
I'm homeless or a runaway
I'm currently in or have aged out of the foster care system
I'm a pregnant female or parent
I'm an individual experiencing a disability
I'm low-income and/or receive public assistance
I'm an English language learner
I'm low-income and require additional assistance to enter/complete an educational program or secure/hold employment
