Trellus IYIP Program Eligibility Questionnaire 
Thank you for your interest!

Please fill out this form completely for eligibility purposes. This is a requirement to be considered for the program.
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Name (First and Last) *
Date of Birth *
MM
/
DD
/
YYYY
E-mail Address *
Phone Number *
Current address
Check Any/All That Apply  *
Required
Eligibility and Barriers
This next list will help us determine eligibility, so please let us know if any of these apply to you. The reason is because our federally funded grant program is designed to target a youth population who are facing economic challenges, and as such, might benefit from extra assistance in finding or keeping employment.

If none apply, you will be considered ineligible for the IYIP program.
Check Any/All That Apply *
Required
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