Youth Radio Fellowship Application

Transcription

1 Youth Radio Fellowship Application Date: Youth Radio 1701 Broadway, Oakland CA PERSONAL INFORMATION First Name: Middle: Last: Address: City: State: ZIP Code: Home Phone: Cell Phone: Address: Date of Birth: Gender: Social Security Number English Fluency (how well do you speak English)? Fluent (English is my first and Primary Language) Somewhat Fluent (speak English pretty well, ELL student) t fluent (English is not my native language, difficulty speaking) Do you speak any other languages? Please check all that apply: Arabic Cantonese English Filipino/Tagalog Hindi Japanese Khmer/Cambodian Korean Mandarin/Putonghua Russian Spanish Vietnamese Other (please specify): Do you have a... (check all that apply)? If not, Youth Radio can help you obtain one. Are you legally eligible for employment in the United States? Drivers License California ID Social Security Card Birth Certificate Passport

2 EDUCATION Have you completed high school or received a GED? If yes, list the names of the school/city and date of graduation: If no, would you be interested in being referred to a program that can help you graduate/obtain a GED? If you have not attempted education past high-school, would you like to? If yes, what sort of education/institution would you be interested in pursuing? If you are not interested in further education, please explain why? Have you attended any other educational institutions? University Community College Vocational School Other (please explain): Please list the name of each institution you have attended and the dates/years of attendance: Please specify the highest level of education that your parent(s) have completed: high school some college college some graduate school graduate school If your parents have not completed high school please list the highest grade completed: About You How did you hear about the Fellowship program?

3 Why does this program interest you? Have you ever had a job? Are you currently employed? If yes, in what industry/field was/is this position? If you have participated in a job training and/or have any formal job training, please list below: the name of the program, the industry, and the dates of attendance. Did you complete the program? Please list the date of completion and any certificate you received. If you did not complete the program, please explain what prevented you from finishing: Have you ever done any of the following? please check all that apply. written a cover letter written a resume interviewed for a job Do you have an interest in digital/social media? If so, please explain below. If not, please move on to the next question. If digital media is not quite your thing, what sort of job experience or training are you interested in? The fellowship program can place participants in jobs/internships in many fields (e.g. maintenance and repair, hospitality, etc):

4 What are your career goals? How do you hope to use the skills and experience you acquire through this program in your future career? SUPPLEMENTAL QUESTIONAIRE Race/Ethnicity: Please check all that apply African American Asian American Caucasian Latino Middle Eastern Native American Pacific Islander Decline to state Other: Have you ever been convicted of a felony? This will not affect your ability to participate in the Fellowship program. If yes, please explain. Youth Radio and the Fellowship program can assist you with the requirements of your probation or parole so please provide as much information as possible. Have you ever spent time in jail? no On parole - contact information of your parole officer Do you currently have a probation officer or court mandated counselor? If yes, please provide their contact information below: Are you dependent on a parent or guardian for financial support? What is your annual household income (your income + your parents/guardians)? You will need to provide documentation.

5 Where do you currently live? with parents/guardian with relatives with roommates alone Other (please specify): What type of housing do you live in? House Apartment Group Home Homeless Other (please specify): Altogether how many people live in your household? Is your house/apartment subsidized housing? (section 8 etc.) Do you have regular access to internet? no Do you/your parents/roommates currently receive welfare (public assistance/afdc/food stamps/social security/section 8/ etc)? can you provide documented proof? Please specify: Have your parents (or those whom you live with) been working in the last year? If yes, please briefly describe their work schedule (i.e. full-time, part-time etc). Do you have dependents (people/children who are financially dependent on you)? If yes, please explain their relationship to you. Please list the contact information of any other counselor or case manager who works with you (e.g. Pathways to change):

6 Please&mark&times&that&you&are&UNAVAILABLE&due&to&prior&commitments: Sunday Monday Tuesday Wednesday Thursday Friday Saturday 7amC8am 8amC9am 9amC10am 10amC11am 11amC12pm 12pmC1pm 1pmC2pm 2pmC3pm 3pmC4pm 4pmC5pm 5pmC6pm 6pmC7pm 7pmC8pm