YouthWorks Student Application

Phone

This field is for validation purposes and should be left unchanged.

Contact Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone Number*

Mobile Phone Number*

School Email Address*

Personal Email Address*

How would you prefer to be contacted?*

Personal Information

Birth Date*

Gender*

What pronouns do you use?

Race*

Which of the following best describes you?

What language(s) does your family speak at home?*

If you enroll in college, would you be the first person in your family to do so?*

Do you contribute financially to support your family at home?*

Does your family receive any of the following?*

Check all that apply.

How did you first hear about YouthWorks?*

Do you have a valid driver's license?*

Will you be driving to school every day next year?*

Expected Graduation Year

Current GPA

Have you ever had a paying job or paying internship?*

Are you currently working?*

Name of current employer

Average hours per week

Please explain your interest in the YouthWorks program and why you think you would be a strong candidate.

I give permission to Project Iowa (YouthWorks) to text me regarding program-related updates and information

Messaging frequency may vary. Message and data rates may apply. You can opt out any time by texting STOP. For assistance, text HELP or visit our website at projectiowa.org. Visit www.projectiowa.org/privacy-policy for privacy policy and www.projectiowa.org/terms-conditions for Terms of Service.

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