Youth Employment Network of Greater Madison - Student Survey
Student Directions: Please complete this survey to indicate your interest in a variety of Summer 2017 employment programs being offered to youth in the Greater Madison area. Some of these programs will provide an opportunity to earn MMSD elective school credit and the Employability Skills Certificate. Your information will be shared with the programs you indicate an interest in and for which you are qualified. You will be contacted by program staff regarding next steps for enrollment.

Students seeking paid employment will need to obtain a work permit. Credentials needed to obtain a work permit include:
1. proof of age - driver's license, birth certificate or passport
2. Social Security Card

Some of these programs seek to serve youth with barriers to employment, including but not limited to, coming from a low-income household, living in challenged neighborhoods, being a teen parent, and having a history of contact with the juvenile justice system and/or foster care system.

Section 1. Contact information
Student First Name
Your answer
Student Last Name
Your answer
Street Address
Your answer
City
Your answer
Zip Code
Your answer
Student Phone
Your answer
Parent/Guardian Phone
Your answer
Student Email
Your answer
Parent/Guardian Email (enter NA if unavailable)
Your answer
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