Project Youth+ Referral - Out of School Youth

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Please complete the form below to apply for the Project Youth+ Out of School Youth Program.

This form is for youth who are not currently attending school

One of our Coaches will be in touch!

Name of applicant (First and Last) *

Age

Youth Phone *

Youth Email *

Are you currently in school?

In school

Not in school

Clear selection

Who told you about this program? *

What county do you live in? *

Jackson

Josephine

Please check all of the following that apply to you:

Currently in school

Currently out of school

I have my diploma

I have my GED

Currently working

Currently looking for work

I have a disability (physical, emotional, mental health, learning disability)

I have/had a 504 or IEP at school

I am pregnant

I am a parent

I have been involved in the juvenile justice system

I speak a language other than English at home

I am or was in Foster Care

I am houseless

I receive SNAP or TANF benefits

What are you looking for support with? *

Finishing my GED or Diploma

Gaining skills for a job

Finding work

College

Other:

Anything else you'd like us to know?

Submit

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