Sutter County One Stop - Youth Eligibility Questionnaire 

Are you currently a high school student attending a high school in Sutter County? 

Want to work, but don't have any experience?  Sutter County One Stop can help you get the experience you need!  

Sutter County One Stop wants to help you!

  • Job Search Assistance
  • Paid Work Experience
  • Training Opportunities
  • Resume/Cover Letter Assistance
  • Learn Interview Techniques

*Applicants must meet eligibility requirement for some services.
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Last Name *
First Name *
Contact/Telephone Number *
Email Address *
What is the best way to reach you? *
What city do you live in? *
What is you current School status?   *
Name of High School *
Are you interested in getting a PAID Work Experience? *
Do you have an IEP in school? *
What is an IEP?  IEP stands for Individualized Education Program.  The purpose of an IEP is to lay out the special education instruction, supports, and services a student needs to thrive in school.  If you are unsure if you have an IEP, you may need to speak with your Parent, Guardian, or Caregiver.
*If YES, a copy of the IEP will need to be provided to confirm eligibility.
Do you have an 504 Plan in school? *
What is a 504 Plan?  A Section 504 Plan is an accommodation plan that requires classroom teachers and other school staff to provide accommodations and/or services necessary for Section 504 eligible students to participate in and benefit from public education programs and activities.  If you are unsure if you have an IEP, you may need to speak with your Parent, Guardian, or Caregiver.
*If YES, a copy of the 504 Plan will need to be provided to confirm eligibility.
Do you have any medical conditions? *
These can include, but are not limited to:  Asthma (Respiratory), Anxiety, Post Traumatic Stress, Clinical Depression, Diabetes, Emotional, Mobility Issues, Hearing Impaired, Immunological, etc.
*If YES, a Doctor's note or Medical Documentation of your diagnosis will need to be provided to confirm eligibility.
Do you acknowledge having a disability?   *
A disability is any condition of the body or mind (impairment) that makes it more difficult for the person with the condition to do certain activities (activity limitation) and interact with the world around them (participation restrictions).  
*If YES, a Doctor's note or documentation of your disability will need to be provided to confirm eligibility.
What is your Date of Birth? *
MM
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YYYY
Does your family receive any type of financial assistance?  (Eligible for Free Lunch Program, CalFresh/Food Stamps, CalWorks)   *
 If you are unsure if your family receives any financial assistance, you may need to speak with your Parent, Guardian, or Caregiver.
Including yourself, how many people live in your household? *
Are your parents English Language Learners (English is their second language)? *
Are you on Probation or have a Record of Arrest? *
Are you housing insecure, homeless or a runaway? *
Are you in the foster care system (foster child) or ever been in the foster care system? *
Are you a Parent and/or currently pregnant? *
Have you been signed up for the Youth Employment Strategies (Y.E.S.) Workshop? *
How did you hear about us?  *
How would you like to hear about future events, such as Job Fairs, Services, etc.? *
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