Intake Application Form

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Intake Application Form

Name*
First Last
Phone Number*
Email Address
Age**
Address*
Street Address Address Line 2 City State/Region * ZIP Code
What career certification are you interested in:*
- Construction
- Certified Nurse Assistant
Do you need a high school Diploma/GED?*
- Yes
- No
Did you graduate from school?*
- Yes
- No
If yes then what School/Year
What was the last graduate you completed?*
What School/Year*
Do you access to a working internet?*
Do you have a computer or laptop?*
How did you hear about YouthBuild?*
Who referred you?
If Other, how did you hear about YouthBuild?

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YOUTHBUILD CHECKLIST

You must attend the Information Session.
You must take the table tests.
You must complete the interview.
You must complete the application.
You must turn in all required documents.
- State picture ID or Passport
- Social Security Card
- Birth Certificate or Passport
- Proof of Address
- Proof of Income
You must complete mental toughness

CNA TRACK Requirements additional(must be 18-24 age)

Must turn in a copy of High School Diploma/GED transcripts or certificate
Must score and 8th grade or higher on the table test
Must complete mental toughness
Must complete Sep 2 TB and physical test (CCAC Form)
Must attend CCAC Informational Session
Must complete CCAC Table test
Must Complete CCAC Application Packet
Must Complete background check (criminal and abuse check)

Important documents you will need during completion of your Application

State picture ID or Passport
Social Security Card
Birth Certificate or Passport
Proof of Address

Additionally, Important Documents for CNA

Step 2 TB and physical Test (CCAC Form)
CCAC Application Packet