ISY Youth Workforce Center Interest Form
Greetings prospective students! Thank you for your interest in the Youth Workforce Center In-School Program. Please complete the following questionnaire. We will respond to your inquiry within three (3) business days.

PLEASE NOTE: BY COMPLETING THIS FORM YOU ARE NOT REGISTERING TO ATTEND VOCATIONAL SCHOOL (CAREER AND TECHNICAL EDUCATION AT NRE HORIZONS REGIONAL EDUCATION CENTERS)

The Youth Workforce Center is an equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities. VA Relay: 711. The Youth Workforce Center is funded 100% through WIOA Title I funds via an award made to NHREC via HRWC via pass through entity VCCS.
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Email *
Student Name *
Student Date of Birth *
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Student Telephone Number *
Student Full Current Address (including city and zip code) *
Current School Status (This program is for 11th and 12th grade ONLY) *
Required
What school are you currently attending? *
Does the student receive any of the following benefits? *
Required
Does the student have a IEP or 504 Plan? *
Is the student currently in foster care? *
Are you a McKinney-Vento student? *
Has the student worked in the last 6 months? If yes, full or part time? *
Required
If employed how much did the student earn per hour? Put 0 if you did not work. *
Did the students parents work in the last 6 months? *
Does the student have any children? *
Has the student ever been arrested or charged with an offense other than a minor traffic infraction? *
Parent/guardian Name *
Parent/Guardian Email Address
 *
Parent/Guardian Telephone Number
 *
How did you hear about us? *
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