Project YouthBuild Application rev. Oct 2018 1
WelcomeDearProspectiveMember,Welcome!Wearesoexcitedthatyouhavechosentotakeasteptowardsmakingadifferenceinyourlife.ProjectYouthBuildislookingforcommittedandmotivatedyouthbetweentheagesof16-24thatlackaHighSchoolDiplomaorGEDandarewillingtosacrificetimeandputintheefforttochangethecourse of their lives.We are now accepting applications and interviewing for the program.Beforestudents are selected, they must register with Santa Fe College’s Adult Education program.PleaseseelastpageforhowtoregisterwithSantaFeCollege.Selected applicants from these interviews will begin a four-day Mental Toughness orientation inFEBRUARY2019.Ifselected,studentswillbeaskedtoparticipateinarigorous9-monthprogram.Ifyouarereadytomakeachange,pleaseensurethatalldocumentsareprovidedandallsectionsoftheapplicationcompleted.Incompleteapplicationswillnotbeconsidered.Pleasereturnallcompletedapplicationsdirectly to theProjectYouthBuildoffice. (635NW6Street,GainesvilleFL,32601)Onceyour completed application (all requested information) is received Project YouthBuild staff willcontactyouforaninterview.DeadlinetosubmityourapplicationisJanuary16,2019.
Ø ApplicationForm □Yes□No
Ø Essay#1 □Yes□No
Ø Essay#2 □Yes□No
Ø Reference#1 (notcompletedbyapplicant) □Yes□No
Ø Reference#2 (notcompletedbyapplicant) □Yes□No
ThefollowinglistofrequireddocumentsMUSTbeturnedinwithyourapplication.
Ø BirthCertificate
Ø Driver’sLicense
Ø SocialSecurityCard
Ø Verificationofhouseholdincome(e.g.paystubs,taxforms,foodstampacceptanceforms)
Ø OfficialcopyofHighSchoolTranscripts(IncludingIEPpaperwork)
Ø SFCRegistration(seelastpage)
Project YouthBuild Application rev. Oct 2018 2
Application2019Thefollowinginformationisusedtodetermineeligibilityandwillbekeptconfidential.CompleteinPEN
Date:______________________________
Name:______________________________________________________________________________________________________□Male□Female
Address:___________________________________________________________________________________________________________________________________
City:___________________________________________________________State:_____________________________________Zip:__________________________
HomePhone:________________________________________________CellPhone:______________________________________________________________
EmailAddress:___________________________________________________________________________________________U.S.Citizen□Yes□NoAge:_______________D.O.B._______________________________________SocialSecurityNumber:_______________/_____________/______________
FaceBookName:_________________________________________________________________________________________________________________________
HaveyouregisteredfortheSelectiveService?(Maleapplicantsovertheageof18)□Yes□No□NotApplicableAreyouofHispanicorLatinoOrigin? □Yes□No□NotSpecifiedWhatisyourrace?
□ AmericanIndianorAlaskan □ HawaiianNativeorPacificIslander □ Asian □ White
□ BlackorAfricanAmerican □ NotSpecified
Doyouhaveanydocumenteddisabilities? □ Yes □ NoIfyes,pleaseprovideIEPorSSDIpaperwork.
Pleasemarkallfieldsthatapply:
□ MigrantYouth □ Low-incomeFamily □ YouthinFosterCare □ HighSchoolDropout
□ YouthOffender □ ChildofIncarceratedParent □ AdultOffender □ Other:________________________
Pleaselistyouremergencycontacts,numbersshouldbedifferentfromyourhomenumbers:
EmergencyContact1:__________________________________________________________________________________________________________________Name Relationship Phone
EmergencyContact2:_________________________________________________________________________________________________________________Name Relationship Phone
WheredidyouhearaboutYouthBuild?
□ Newspaper □ Radio □ Television □ Flyer □ School
□ Friend □ CraigsList □ FaceBook □ Other_________________________________________________
□ DoyouknowanyonethatattendedYouthBuild:_______________________________________________________________________________
Project YouthBuild Application rev. Oct 2018 3
EDUCATIONALBACKGROUND
DoyouhaveaHighSchoolDiploma? □Yes □NoDoyouhaveaGED?□Yes□NoWhatisthelastschoolyouattended?______________________________________________________________DateAttended:___________________________________ Lastgradeyoucompleted?__________________
TRAININGandWORKHISTORY
Haveyoueverbeeninanothertrainingprogram?(ex.WIOASummerYouth,JobCorps,YouthBuild) □Yes□No
Ifyes,givenameandlocationofprogram:_________________________________________________________________________________________
Dateyouattendedprogram:_____________________________________Didyoucompletetheprogram?□Yes□NoCurrentJob(ifapplicable)
Areyoucurrentlyworking? □Yes □No Isyourjob? □Part-time □Full-time Whatisyourcurrenthourlywage?__________________Averagenumberofhoursworkedperweek?__________________________CurrentWorkSchedule:_____________________________________________________________________________________________________________NameofBusiness____________________________________________________________________________________________________________________Phone_______________________________________________________Whatkindofworkdoyoudo?______________________________________
Supervisor’sName:___________________________________________________________Canwecallyoursupervisor?□Yes □NoConstructionExperienceWhataboutconstructioninterestsyou?________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Haveyouhadanyconstructionexperience? □Yes □NoIfso,pleasedescribethisexperience____________________________________________________________________________________________
HEALTHINFORMATION
Doyouhaveanyphysical,mentaland/oremotionalhealthproblems? □Yes □NoIfyes,pleasedescribe:____________________________________________________________________________________________________________
Doyoutakeanymedications? □Yes □NoIfyes,pleaselist__________________________________________________________________________________________________________________
Areyousupposedtowearglassesorcontacts? □Yes □NoDoyouhaveasthma? □Yes □No
Project YouthBuild Application rev. Oct 2018 4
Doyouhavediabetes? □Yes □NoDoyouhaveanyknownallergies? □Yes □NoIfyes,what?_______________________________________________________________________________________________________________________
Doyousmoke? □Yes □NoWhenwasthedateofyourlastphysicalexamination?_______________________________________________________________________
CRIMINALBACKGROUND
AnswerthissectionHONESTLY—wecompleteLevelIIBackgroundScreeningsonEACHstudent,ifyouaredishonestonthissectionitmayeliminateyoufromselection
Haveyoueverbeenarrested,convictedorheldinpolicecustody? □Yes □NoIfyes,pleasedescribe______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Areyouonprobation,parole,orinvolvedwithcorrections? □Yes □NoIfyes,probation/paroleofficer________________________________________________________Phone#______________________________
**Pleaseprovidedocumentationofthetermsofyourprobationandupcomingcourtdates.
ADDITIONALINFORMATION
Doyouhaveadriver’spermitordriver’slicense? □Yes □NoDoyouownacar? □Yes □NoSampleYouthBuildSchedule
IfacceptedwillyouconsistentlyattendMondaythroughFriday8:30-4:00? □Yes□NoExplainhowyouwillarriveordeparteachdayfromProjectYouthBuild?(ex.Dropoffbyfriend,RTS,bike,etc.)__________________________________________________________________________________________________________________________________________Numberofpeopleinyourhousehold,includingyou:_______________,Pleaselistnamesofeachpersonlivinginyourhome:___________________________________________________________________________________________________________________________________________Whatisyourcurrentlivingstatus(selectanythatapply)?
□Livingwithfamily □Livingalone □Livingwithfriends □Livinginahomelessshelter□Livinginahalfwayhouse □Homeless □Other:_________________________________________________________
TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY8:30am-12pm EducationBlockorConstructionBlock Internship/Impact
Hours12-12:45pm LUNCH12:45pm-3:45pm
EducationBlockorConstructionBlock Internship/ImpactHours
Project YouthBuild Application rev. Oct 2018 5
Whopaysthemajorityofyourhouseholdbills?__________________________________________________________________________________
Areyouaparent?□Yes□NoIfyes,pleasegiveyourchild’snamesandages:_________________________________________________________________________________________________________________________________________________________________________________
Doyouoranyonewithinyourhouseholdreceiveanyofthefollowing?Selectallthatapply
□ SocialSecurityDisabilityInsurance(SSDI) □ SupplementalSecurityIncome(SSI) □ FoodStamps
□ TemporaryAssistancetoNeedyFamilies(TANF) □ Unemployment □ SubsidizedHousing
Pleaselistanyotherservicesyouarereceiving:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
ApplicantSignature___________________________________________________________________ Date:_____________________________________
Project YouthBuild Application rev. Oct 2018 6
ShortAnswer#1Topic:Explainwhyyouwouldliketobeintheprogram;includewhyweshouldconsideryoufor
ProjectYouthBuild.Requirements:Minimumoftwo(2)paragraphs______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
Project YouthBuild Application rev. Oct 2018 7
ShortAnswer#2Topic:Givetwoexamplesofplacesyouwouldliketovolunteeratandwhythoseplacesareimportanttoyou?Requirements:Minimumoftwo(2)paragraphs______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
Project YouthBuild Application rev. Oct 2018 8
ReferenceCheckSectionmustbecompletedbyeitherapersonalorprofessionalreference;nottobecompletedbystudent.
StudentName:____________________________________________________________________________________________________NameofReference:______________________________________________________________________________________________TelephoneNumber:_________________________________________RelationshiptoCandidate:_____________________Email:_____________________________________________________________________________________________________________Pleaseanswerthequestionsbelowtothebestofyourability.
1. Howlongandinwhatcapacityhaveyouknowntheabovenamedstudent?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2. Whatwashe/sheresponsiblefor?
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3. Whatarehis/herstrengthsandweaknesses?
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
4. Howdoeshe/sheinteractwithauthorityfigures?
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
5. Pleasedescribehowthestudentinteractswithothers?
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
AdditionalInformation(ifneeded):______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Project YouthBuild Application rev. Oct 2018 9
ReferenceCheck
Sectionmustbecompletedbyeitherapersonalorprofessionalreference;nottobecompletedbystudent.
StudentName:____________________________________________________________________________________________________NameofReference:______________________________________________________________________________________________TelephoneNumber:_________________________________________RelationshiptoCandidate:_____________________Email:_____________________________________________________________________________________________________________Pleaseanswerthequestionsbelowtothebestofyourability.
1. Howlongandinwhatcapacityhaveyouknowntheabovenamedstudent?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2. Whatwashe/sheresponsiblefor?
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3. Whatarehis/herstrengthsandweaknesses?
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
4. Howdoeshe/sheinteractwithauthorityfigures?
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
5. Pleasedescribehowthestudentinteractswithothers?
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
AdditionalInformation(ifneeded):______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Project YouthBuild Application rev. Oct 2018 10
HowtoRegisterwithSantaFe:
1. Applyonlineatwww.sfcollege.edu2. Scrolldown,clickon“Apply.”3. Ontheright,clickonthe“ApplyNow”button.4. Press“StartNewApplication.”5. Click“USCitizen”(unlessyouarenotaUSCitizen”andthenclick“Next”6. Click“Non-DegreeSeeking”
Printorwritedownyour8-digitSFID#_________________--____________________FILLOUTONLINEorPRINTOUTanyrelevantpaperworkthatisrequested.ThisincludestheFloridaResidencyForm,whichisaveryimportantdocumenttoturnin.Youmayneedtobringdocumentationtothecampuslocationyouareinterestedinattending.
