Youth Apprenticeship Readiness Program Form

Palo Alto College is preparing young adults to enter careers in finance and advanced manufacturing through a Youth Apprenticeship Readiness Grant (YARG) awarded by the U.S. Department of Labor.

The program includes a combination of classroom and hands-on learning to help young adults (age 16-24) earn industry-recognized certifications in the advanced manufacturing and finance industries. They are able to earn wages while they learn and develop skills that employers value.

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* First Name:

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* Middle Name:

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* Last Name:

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* Date of birth:

MM/DD/YYYY

Date

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* Contact information:

Street Address:

City:

State:

Zip Code:

County:

Phone:

Email:

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* If you are you currently enrolled in school, which school do you attend? (Enter N/A if not currently enrolled)

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* If you are currently enrolled at ACD, your Banner ID:

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* Employment Status:

Full-time

Part-time

Unemployed (26 weeks or less)

Unemployed (27 weeks or longer)

Neither working nor looking for work

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* Which fields would you be interested in? (please select all that apply):

Advanced Manufacturing

IT/Cyber Security

Finance

Insurance

Logistics

Other (please specify)

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* Which of the following supports do you need to begin an educational program or secure employment? (choose all that apply)

Assistance covering childcare expenses

Employment resources for individuals with disabilities

Assistance securing future employment

Employment resources for individuals involved with the criminal justice system

Transportation assistance

Accessing English as a Second Language (ESL) courses

Assistance with either housing or food insecurity

Applying for financial aid and/or emergency aid

Assistance paying for employment related training

Other (please specify)

None

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* First Name:

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* Middle Name:

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* Last Name:

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* Date of birth:

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* Contact information:

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* If you are you currently enrolled in school, which school do you attend? (Enter N/A if not currently enrolled)

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* If you are currently enrolled at ACD, your Banner ID:

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* Employment Status:

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* Which fields would you be interested in? (please select all that apply):

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* Which of the following supports do you need to begin an educational program or secure employment? (choose all that apply)

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* Referral source: