accès:succès Application Form - Fall 2022

accès:succès is a Pre-Employment Program by L’Annexe, the Ometz Centre for Young Adults.

The program is for young adults between the ages of 16-35 facing barriers to meaningful, sustainable employment and/or personal independence. The overall goal is for participants to engage with the professional sphere through work exposures whilst gaining confidence to fuel their skill sets further.

General Information

The program consists of 6-weeks of workshops and work exposure.

Start Date: November 1st, 2022
Days: Tuesday, Wednesday and Thursday
Times: 10:00 am to 1:00 pm
Cost: FREE

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* 1. Today's Date

(MM/DD/YYYY)

Date

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* 2. Person filling out 'Application Form'

please indicate if you are filling out on behalf of participant named below

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* 3. Full Name (participant):

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* 4. Date of Birth (participant):

(MM/DD/YYYY)

Date

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* 5. Telephone number (participant):

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* 6. E-mail (participant):

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* 7. Please advise the best form of contact (tel, text, e-mail, parent/guardian communication)

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* 8. Emergency Contact Information (guardian/parent/other):

Name:

Relationship:

Tel:

E-mail:

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* 9. How did you find out about this program?

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* 10. Please list any medical conditions or health concerns that the program facilitator may need to be aware of (for example - allergies, asthma, epilepsy, etc.)

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* 11. Please list any experience of work, volunteer or internship (stage)
if you have not yet had a job, no problem!

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* 12. Are you comfortable taking public transit on your own?

Yes

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* 13. Are you available to attend all 6-weeks (Nov 1st-Dec 8th)

Yes

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* 14. If not, please check off which any dates you are NOT available

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* 15. Please leave any other information you feel would be beneficial and/or necessary for program coordinator/facilitator to know

Thank you for submitting the application form

The program coordinator will be in touch shortly

accès:succès Application Form - Fall 2022

Question Title

* 1. Today's Date

Question Title

* 2. Person filling out 'Application Form'*please indicate if you are filling out on behalf of participant named below*

Question Title

* 3. Full Name (participant):

Question Title

* 4. Date of Birth (participant):

Question Title

* 5. Telephone number (participant):

Question Title

* 6. E-mail (participant):

Question Title

* 7. Please advise the best form of contact (tel, text, e-mail, parent/guardian communication)

Question Title

* 8. Emergency Contact Information (guardian/parent/other):

Question Title

* 9. How did you find out about this program?

Question Title

* 10. Please list any medical conditions or health concerns that the program facilitator may need to be aware of (for example - allergies, asthma, epilepsy, etc.)

Question Title

* 11. Please list any experience of work, volunteer or internship (stage) *if you have not yet had a job, no problem!*

Question Title

* 12. Are you comfortable taking public transit on your own?

Question Title

* 13. Are you available to attend all 6-weeks (Nov 1st-Dec 8th)

Question Title

* 14. If not, please check off which any dates you are NOT available

Question Title

* 15. Please leave any other information you feel would be beneficial and/or necessary for program coordinator/facilitator to know

* 2. Person filling out 'Application Form'

please indicate if you are filling out on behalf of participant named below

* 11. Please list any experience of work, volunteer or internship (stage)
if you have not yet had a job, no problem!