) Kollab Youth Application Form

To apply to Kollab Youth's Summer Session, all youth applicants must complete the form below. The deadline to apply is Monday, July 1st, 2024 by 5:30 PM.

Once we have received your application, the next steps will be sent directly to the applicant's email address.

Requirements to apply:

Applicants must be between the ages of 14 to 19 years old.
Applicants must have a strong commitment to the program schedule.
New applicants must complete a one-on-one interview with a Kollab staff member. Returning members are not required to interview.
All applicants must complete a parent consent form if they are under 18 years old. The parent consent form is available on Kollab Youth's registration page, scroll down to find it.
Kollab Youth provides low-income underserved youth with an exceptional program in workforce development within a nurturing environment, empowering teens to develop their potential, pursue their education and careers while strengthening their communities and it is free.

About Kollab Youth's program:

Summer Session Timeline: July 8th to August 16th (6 Weeks)
Virtual classes are every Wednesday and Thursday from 4:30 PM to 5:30 PM. Attendance is required.
Applicants, who are over 16 years old, have the option to be paired up with a professional mentor who will support them through the program. Find more about mentorship here.
Applicants, who are over 15 years old can be enrolled as pre-apprentices, where they can obtain paid job opportunities.
Youth can win various prizes such as tablets, gift cards, school supplies, etc.

Questions? Email: schaparro@kollabyouth.org

For more information, visit: kollabyouth.org. To stay connected with Kollab Youth News, click here to subscribe to our e-newsletter.

Question Title

* 1. Please fill out the contact information of the applicant.

Youth FIRST Name

Youth LAST Name

Address

City/Town

State/Province

ZIP/Postal Code

Youth's Personal Email Address (Non-school email)

Youth's Phone Number

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* 2. Applicant's Birthdate (Month/Day/Year)

Select Birthdate

Date

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* 3. Applicant's Gender

Female

Male

Other (specify)

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* 4. What race/ethnicity best describes the applicant? (Please choose only one.)

American Indian or Alaskan Native

Asian / Pacific Islander

Black or African American

Hispanic

White / Caucasian

Multiple ethnicity / Other (please specify)

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* 5. What grade is the applicant?

9th grade

10th grade

11th grade

12th grade

Fifth year / Other

Other (please specify)

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* 6. Which high school or college is the applicant attending?

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* 7. Is the applicant currently enrolled in any dual enrollment courses?

Yes

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* 8. What is the applicant's affiliation? (Name of your Boys & Girls Club, Nonprofit, School District)

Antelope Valley Boys and Girls Club

Boys & Girls Clubs of the Los Angeles Harbor

Santa Clarita Valley Boys & Girls Club

Boys & Girls Club of San Fernando Valley

Boys & Girls Club of Burbank and Greater East Valley

West Valley Boys & Girls Club

Boys & Girls Club Hollywood

Variety Boys & Girls Club

Non-Club member

DCFS

YMCA

Other Affiliation (please specify)

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* 9. Name and email of your parent/guardian. Parents/Guardians, stay connected with Kollab Youth News, click here to subscribe to our e-newsletter.

FIRST Name *

LAST Name

Email Address *

Phone Number *

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* 10. If you are a member of a Boys & Girls Club, School District, or other Nonprofit, please provide the name and email of your staff member contact. If you do not have a staff contact, please leave it blank.

FIRST Name

LAST Name

Email Address

Phone Number

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* 11. FOR 15 YEARS AND OLDER: I acknowledge my Social Security number (SSN) will be collected by Kollab Youth if I would like to be registered as a pre-apprentice. (If you have any questions please reach out to schaparro@kollabyouth.org)

I acknowledge

I do not have a Social Security Number

I am under 15 years old

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* 12. Is the applicant a Veteran?

Yes

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* 13. Is one of your parents a member of the military or a veteran?

Yes

Unsure/Prefer not to answer

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* 14. Does your family receive CalWORKs or/and CalFresh? Check all that apply.

CalWORKS

CalFresh

Reduced/Free Lunch

Food Stamps (SNAP)

Medicaid

Social Security

Federal Public Housing (section 8, HUD housing, etc...)

Federal Pell Grant

Veteran's Pension

Women, Infants & Children (WIC)

Low Income Home Energy Assistance Program (LIHEAP)

Supplemental Security Income (SSI)

None

Other (please specify)

Question Title

* 15. What was your total family income before taxes?

Less than $30,000

$30,000 to $40,000

$40,000 to $50,000

$50,000 to $60,000

$60,000 to $70,000

$70,000 to $80,000

$80,000 to $90,000

$90,000 to $100,000

$100,000 or more

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* 16. How many people, including yourself, currently live in your household?

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* 17. Please check all that apply to Kollab Youth teen's status.

Homeless

Foster Youth

Re-entry (probation)

None of the above

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* 18. What social media platform do you use? Check all that apply. And make sure to follow us on our platforms: Instagram | Twitter | LinkedIn | Facebook

Tik Tok

Instagram

Twitter

Facebook

Snapchat

Other (please specify)

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* 19. Please share your social media handles and which platforms.

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* 20. Do you have a smart device (Tablet, Desktop or Laptop) and wi-fi?

Yes, I have both

Only wifi

Only Smart Device

None of the above

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* 21. Share your career industry interest...

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* 22. FOR 16+ ONLY: Kollab applicants who are 16 years old and older have the option to be assigned a mentor who will increase their opportunities for success. If you opt-in, you will need to 1) provide a letter of recommendation to be paired with a mentor, 2) attend a mandatory mentee orientation, and 3) complete a mentee pledge form.

Opt-out; I would not like a mentor.

Opt-in; I would like a mentor.

I am under 16 years old.

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* 23. You MUST upload the parent consent form if you are under 18 years old. You can find the parent consent form on Kollab Youth's registration page, scroll down to find it. If you are having trouble uploading the form, please email it to Sari Chaparro at schaparro@kollabyouth.org.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 24. How did you hear about Kollab Youth?

Instagram

Twitter

Facebook

Friend/Family

Boys & Girls Club

Other (please specify)

By submitting this form, you agree to receive text messages from Kollab Youth at the number provided, related to program information, opportunities, and weekly status updates. Additionally, you authorize the receipt of our electronic newsletter from which you can unsubscribe by clicking the unsubscribe link at the bottom of those emails. Message and data rates may apply. Message frequency varies. Unsubscribe at any time by replying STOP, and reply HELP for help. Click here to view Kollab Youth's Privacy Policy.