Cowlitz/Wahkiakum Next Application
Thanks for attending orientation! Please complete the application below. Some of the questions below may feel personal, We ask them so that we can start thinking about what resources might support you best - that way we can come to our first appointment with some options for you! Please answer as openly and honestly as you feel comfortable.We're here to help!

By completing this application, you are agreeing that your basic information may be shared with the Next staff, which include partners from Equus, ESD 112, Longview Goodwill, WorkSource, and Job Corps.
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First Name *
Last Name *
Gender *
Pronoun (please select the words you use to describe yourself) *
Race *
Ethnicity *
Phone number *
Date of Birth *
Parent/Guardian First and Last Name
Parent/Guardian Phone Number
How did you learn about Next? *
Are you currently enrolled in school? (It's okay if you are not! This is not a bad thing here. We want to help you get what you need!) *
What school do you or did you attend last? *
What county do you live in? *
Do any of the following things apply to you? Check all that apply.
What are you needing assistance with? Check all that apply.
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