Thank you for your interest in the Summer Training and Enrichment Program (STEP) 2015 You must be between the ages of 16 and 24 at the start of the program on June 17, 2015. You must provide proof that you live in the Southeast Community of Newport News (broadly defined as south of Mercury Boulevard). INSTRUCTIONS: Complete and return this STEP Application ASAP to one of the following drop-off sites: C. Waldo Scott Center, 3100 Wickham Avenue, Newport News Doris Miller Community Center, 2814 Wickham Avenue, Newport News Downing Gross Cultural Arts Center, 2410 Wickham Avenue, Newport News Good Seed Good Ground, 115 – 28th Street, Newport News Hampton-Newport News Community Services Board, 500 Medical Drive, Suite B, Hampton Heritage High School, 5800 Marshall Avenue, Newport News Newport News City Hall, Lobby Security Desk, 2400 Washington Avenue, Newport News Newport News Department of Human Services, Lobby Reception Desk, 6060 Jefferson Avenue Newport News Redevelopment and Housing, 618 – 18th Street, Newport News Pearl Bailey Library, 2510 Wickham Avenue, Newport News The Moton Community House, 2101 Jefferson Avenue, Newport News If accepted, you will be contacted by phone or email. Please make sure your contact information is correct. If we cannot reach you, you will lose your place in the program. You will be required to provide proof that you live in the target area. CONTACT INFORMATION: Your Name: __________________________________________ Last _______________________________________ First Address: __________________________________________ Street ___________________________ City ______ MI ______________ Zip Code Phone Numbers: ________________________________ Cell Number ___________________________ Home Number Is it okay if STEP sends you text messages? [ ] Yes [ ] No ____________________________ Alternate Number If Yes, to which number? ______________________ Email Address: ___________________________________________________________________________________ 2015 1 INFORMATION ABOUT YOU: Please tell us about yourself How old will you be on June 17, 2015? (Please Check One) Do you have a resume? [ ] Yes [ ] No [ ] I Don’t Know [ ] 16 or 17 [ ] 18 to 24 What size t-shirt do you wear? (STEP t-shirts will be provided) [ ] Small [ ] Medium [ ] Large [ ] XL [ ] 2X [ ] 3X EDUCATION: Please complete the following questions about your educational background. (Your education status WILL NOT be used to determine your eligibility for this program.) My current school/completion status is: [ ] College Student [ ] High School Student What grade? [ ] 9th Grade [ ] 10th Grade [ ] 11th Grade [ ] 12th Grade [ ] High School Graduate [ ] GED Recipient [ ] Student Who Left High School Before Graduating GED Preparation Classes will be available FREE to eligible STEP program participants during the summer. If selected for STEP, would you enroll in free GED classes? [ ] Yes [ ] No [ ] I Need More Information Classes will be held once a week for 3 hours. (Eligible participants who successfully complete the GED class will receive a completion stipend at the end of the summer.) GED Classes for STEP will be held in the 3rd Floor Classroom at Downing-Gross Cultural Arts Center. (Dates and times to be determined.) INTERESTS: Why do you want to participate in this summer program? (Please choose up to 3 from the list below.) [ ] Have something to do during the summer [ ] Get work experience [ ] Learn new skills [ ] Make new friends [ ] Earn money for things I want to buy for myself [ ] Earn money to help support my family [ ] Earn money for college [ ] See if I like a certain industry or career [ ] Learn something about myself [ ] Build my resume for other jobs or for college [ ] Other – Describe:_________________________________________________________ 2015 2 EMPLOYMENT INFORMATION: Have you ever worked for pay before (i.e. held a job) [ ] No you have prior work experience: [ ] Yes If yes, please share if Most Recent Employer: _____________________________________________________________________________ Type of Business: __________________________________________________________________________________ Location: _________________________________________________________________________________________ Your Job Duties: ___________________________________________________________________________________ Start Date:________________________________________ End Date:________________________________________ Previous Employer: ________________________________________________________________________________ Type of Business: __________________________________________________________________________________ Location: _________________________________________________________________________________________ Your Job Duties: ___________________________________________________________________________________ Start Date:________________________________________ End Date:________________________________________ Check three types of work you might like to do: (There is no guarantee you will be placed in your selected choices.) ___ Working In An Office (Paperwork, Organizing, Answering Phones) ___ Hospitality and Tourism / Greeting, Welcoming, and Guiding Visitors (Indoors / Outdoors) ___ General Cleaning and Maintenance (Inside) ___ Landscaping / Cleaning and Maintenance (Outside) ___ Working with Younger Children (**Will Require a Background Check**) ___ School Clean Up / Set Up for Next School Year ___ Other – Describe:_______________________________________________________________ MY PLANS AFTER SUMMER: [ ] Return to High School [ ] Start or Return to College [ ] Obtain Full Time Employment [ ] Other – Describe:________________________________________________________ 2015 3 IMPORTANT DATES for STEP: May 11 Notification Begins: Accepted applicants contacted by email or phone Mandatory Registration Sessions will be held on Saturday, May 30 at 10:00 a.m. to 12 Noon or Tuesday, June 2 at 6:00 p.m. to 8:00 p.m. for all accepted STEP applicants. All selected applicants will have to attend one of these sessions to qualify for enrollment. For applicants under age 18, a parent or legal guardian must also attend. (Location to be determined.) STEP will be in session from June 17 through August 25 June 17, 18 and 19 Mandatory STEP Orientation STEP enrichment days and field trips will be Every Friday (and Possibly Mondays) Stipends will be paid weekly on Friday, beginning the week of July 3 (first week delayed) Optional GED class will begin the week of July 6 APPLICANT CERTIFICATION: I certify that the information provided in this application is true to the best of my knowledge. I am also aware that the information I have provided is subject to review and verification and that I may have to provide additional documentation to support this application. I am also aware that I am subject to immediate termination if I am found ineligible after enrollment, for misconduct during the program, or for other good cause. I allow release of this information for verification purposes, and understand that it will be used to determine eligibility. If I am under 18, my parent/guardian’s signature grants me permission to participate in this program. Applicant Signature Date Parent/Guardian Signature Date Required if applicant is under the age of 18 ****FOR INTERNAL USE ONLY**** STEP Application Submission Information: Date Returned _______________________ Time ____________________(a.m. / p.m.) Received By (Name): ___________________________________________________________ Returned To (Please Check One): [ [ [ [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] ] ] ] C. Waldo Scott Center, 3100 Wickham Avenue, Newport News Doris Miller Community Center, 2814 Wickham Avenue, Newport News Downing Gross Cultural Arts Center, 2410 Wickham Avenue, Newport News Good Seed Good Ground, 115 – 28th Street, Newport News Hampton-Newport News Community Services Board, 500 Medical Drive, Suite B, Hampton Heritage High School, 5800 Marshall Avenue, Newport News Newport News City Hall, Lobby Security Desk, 2400 Washington Avenue, Newport News Newport News Department of Human Services, Lobby Reception Desk, 6060 Jefferson Avenue Newport News Redevelopment and Housing, 618 – 18th Street, Newport News Pearl Bailey Library, 2510 Wickham Avenue, Newport News The Moton Community House, 2101 Jefferson Avenue, Newport News STEP is an equal opportunity program. We will not discriminate based on your race, color, national origin, sex, age, disability, or religion. Funding for the STEP program is provided by the Newport News Youth & Gang Violence Prevention Initiative www.nnva.gov www.pcfwd.org 2015 4
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