Youth Conservation Corps Member Application YCC Member Application This 6-12 month program focuses on education, career pathways in Construction or IT and building life skills and leadership skills. We want to see every member complete their high school diploma or GED, earn industry-recognized certifications in construction or IT career pathways and learn valuable life skills in order to gain long-term employment. Youth Conservation Corps is located in Waukegan, IL and is offered to Lake County residents. Only proceed with this application if you are a resident of Lake County, Illinois, are 16-24 years old and are interested in participating in this 6-12 month workforce readiness program. * I live in Lake County, Illinois, and am 16-24 years old. Your First Name * Your Last Name * Email Address * Mobile Phone Number * Home Phone Number * Address * City, State, Zip * Date of Birth (MM/DD/YYYY) Example: 01/01/2000 Sex * Male Female Do you have a valid Social Security Number (SSN)? * Yes No Do you currently receive any government assistance? Yes No If yes, what kind (i.e. housing, food stamps, etc)? What type of housing best applies to you? * House Apartment Public Housing Halfway House Homeless Shelter Group Home Other Who do you live with? Parents Other Family Alone Roommates Spouse/Partner Race/Ethnicity Black / African American Hispanic / Latino White / Caucasian Native American Other Last School Attended Last Grade Attended 7th Grade8th Grade9th Freshman10th Sophomore11th Junior12th Senior Last Year Attended 202120202019201820172016201520142013201220112010 Have you received a high school diploma? * Yes No If you didn't finish high school, why not? Have you completed the GED Program? * Yes No If no, what GED tests have you completed? Have you held a job before? * Yes No Are you currently working? * Yes No If yes, hourly rate? If yes, hours per week? Name of Company Job Title Are you now on probation * Yes No If yes, what is your Probation Officer's name? If yes, what is your Probation Officer's phone number? Are you currently on parole? * Yes No If yes, what is your Parole Officer's name? If yes, what is your Parole Officer's phone number? If any, please list scheduled or pending courts dates What is the size of your household (the number of persons currently living together in your home, including yourself ) * What is your estimated annual household income? $0-$13,400$13,400-$26,80026,900-$40,210$40,210-$53,620$53,620-$67,020$67,020+ I certify that the above information is true and correct to the best of my knowledge. * Yes Do you have a current driver’s license, state-issued ID card (not high school) or passport? * Yes No What is the expiration date of your identification (month/day/year)? How did hear about YCC? * YCC Website Current or Past YCC Member Social Media Flyer, postcard, or sign. YCC Van Counselor or Probation Officer Other If you answered friend or family member above, who referred you to YCC? reCAPTCHA If you are human, leave this field blank. Submit Δ
