TCWD Youth Services Interest Survey

1.Your Information(Required.)

First Name (legal name on your birth certificate)

Last Name (legal name on your birth certificate)

Preferred Name

Phone Number

Email Address

2.How do you prefer we contact you?
(select the method you check most often)(Required.)

Text

Phone Call

Email

3.Do you live and/or go to school in Tompkins County?(Required.)

Yes, I live, work, or attend/will attend school in Tompkins County.

No (you may still complete this form).

4.If you live outside of Tompkins County, do any of the following apply to you?

I can get help with transportation or carpool to Tompkins County

A close family member or partner lives in Tompkins County who I visit often

I am planning to move to Tompkins County

None of the above

5.Please tell us your age and school status as of today?(Required.)

I am ages 14-21 and I am in school (includes middle school, high school, BOCES, or college).

I am ages 16-24 and I do not attend school OR will be graduating before February 1, 2023.

Neither of these are true of me. If you submit this form, our staff will refer you to another program and services if you are 25.

7.Please tell us about your household(Required.)

My parent or legal guardian is currently incarcerated.

In the last 6 months, myself or my household has received SNAP (food stamps), SSI, TANF, HEAP, or Medicaid.

I and/or my household has no income.

I am not sure if these situations apply to me.

None of these apply to me.

8.Please tell us about your employment history(Required.)

I have never had a paid job.

I have been "let go" or fired from a job in the last 12 months (1 year).

I have never held a full-time (30 hr/week) job for more than 13 weeks (4 months) in a row.

I currently have a paid job.

I have had a paid job in the last 12 months (1 year), but I don't know the dates/details.

Other (please specify)

10.From the list below, which kind of job(s) are of interest to you? (Options are based on current JobLink worksite openings as of January 2023)

Other (please specify)

11.How did you hear about JobLink(Required.)

Family member

Teacher, professor or school guidance counselor

Friend participating in JobLink

Caseworker or therapist

Facebook or Instagram post

Department of Labor worker at Center Ithaca

Other (please specify)

12.Do you have any questions for staff?