Students applying for the paid Summer Employment Program must be able to complete a part-time internship during the summer, meet eligibility requirements which may include income information, and pass a background check and drug screen with the payroll entity.  Please complete this information, and you will be contacted by a CareerSource Gulf Coast Case Manager to determine if you are eligible and help you with registration. Feel free to call Linda Cohen at 850-872-4340 ext. 8110 for more information.

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* 1. Address

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* 2. Parent/Guardian name

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* 3. Parent/Guardian phone number

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* 4. Parent/Guardian email address

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* 5. Student's Date of Birth

Date

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* 7. Are you graduating in May of 2022?

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* 8. Will you be entering your Senior year in August 2022?

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* 9. What CTE Program are you enrolled in?

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* 10. Are you currently working?

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* 12. Are you available and able to complete a paid internship this summer (20 - 30 hours per week)?

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* 13. Please answer the questions below

  Yes No Unknown
Do you have a family member that did NOT graduate from High School?
Have your parents ever been incarcerated?
Do you live in a nontraditional household (single parent, live with grandparents, live with unofficial guardian, etc.)
Have you ever been involved with the justice system?
Are you homeless or a runaway?
Are you in foster care?
Are you pregnant or parenting?
Do you have a disability (including learning disabilities)
Do you have a parent in the military that is deployed?
Does anyone in your household receive Food Stamps or any other type of public assistance?
Do you have a parent that is unemployed, underemployed, or self employed?

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* 14. In the past six months, have you worked for the same employer full time (more than 30 hours per week)?

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* 15. Do you have the following?

  Yes No
Reliable transportation
A valid driver's license
Valid car insurance
Have your own car

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