Please note: All applicants must attend an information session before your application will be processed. You can sign up for an information session here. Contact InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Cell Phone*Email* Background InformationDate of Birth* Date Format: MM slash DD slash YYYY What is your gender?*Please choose an option belowMaleFemaleNon-BinaryWhat ethnic group do you identify as*Please hold down the "Ctrl" button and click all of the choices that apply to you. American Indian/Alaskan NativeAsianBlack or African AmericanHispanic/LatinoMiddle EasternNative Hawaiian/Pacific IslanderWhiteHow did you hear about StreetWise?*Please choose an option belowAlumni of the programCommunity CollegeFour year collegeTraining ProgramSocial Service AgencySocial MediaStreetWise Partners' volunteerWebsiteOtherIf you were referred by a social service agency, training program, college, or other organization, what is the name of the organization that referred you?If you were referred by an alumni or volunteer, what is their name?Are you a U.S. Citizen?*YesNoIf you are not a U.S. citizen, what documents allow you to work legally in the U.S.?*If you are a U.S. citizen select "Not Applicable"Please choose an option belowNot ApplicableGreen Card (permanent resident card)Work PermitI-97EINStudent VisaI'm not eligible to work in the U.S.OtherIf other, please explainIs English your first language?*YesNoAre you a first generation American or recent immigrant?*Please choose an option belowNoFirst Generation AmericanRecent ImmigrantRefugee/AsyleeAre you the first person in your family to go to college?*Please choose an option belowYesNoI did not / do not attend collegeHave you ever served in the United States Armed Forces?*Please choose an option belowYes, I am on Active DutyYes, I am a VeteranNo, I have never servedPlease indicate your marital status*Please choose an option belowSingleMarriedSeparatedDivorcedWidowDivorce or Separation ProcessAre you a caretaker and/or responsible for anyone under the age of 18?*YesNoFinancial InformationHow much money did you make in the last year?*Please estimate to the best of your abilityHow many people are you financially supporting?*This includes yourselfPlease choose an option below01234567+What was your household income last year?*This includes spouse or family members living in your home.Please choose an option belowLess than $25,000$25,000 to $34,999$35,000 to $49,999$50,000 to $74,999$75,000 to $99,999$100,000 to $149,999$150,000 to $199,999$200,000 or moreHow many people are in your household?*This includes spouse/partner, parents, siblings, children, extended family, etc.Please choose an option below1234567+Is anyone else financially supporting you?*YesNoSocial ServicesDo you receive any social services?*YesNoPlease select all services you receive.*Please hold down the "Ctrl" button and click all of the choices that apply to you. If you do not receive social services select "Not Applicable".Not ApplicablePublic AssistanceHousing AssistanceFood StampsUnemployment BenefitsDisabilitySocial SecurityDo you have a history of substance abuse?*This will not affect your eligibility for the program. It will help us match you with a mentor.YesNoHave you ever been convicted of a crime?*This will not affect your eligibility for the program. It will help us match you with a mentor.YesNoIf you have been convicted of a crime please explain:EmploymentAre you currently employed?*YesNoWhich one of the following shifts do you work?*If you are not currently working select "Not Applicable"Please choose an option belowNot ApplicableFull-TimePart- TimePer DiemTemporaryName of Employer*If you have more than one indicate your primary employer. If you are not employed write "Not Applicable".What is your job title?*If none, write "Not Applicable"Are you currently looking for employment?*YesNoWhat shifts are you looking to work?*Please hold down the "Ctrl" button and click all of the choices that apply to you. If you are not looking for work select "Not Applicable".Not ApplicableFull-TimePart-TimePer DiemTemporaryInternshipWhat industry are you most interested in?*Please choose an option belowAccountingAdvertising and MarketingConsulting - FinancialConsulting - IT (technology)Consulting - Human ResourcesConsulting - Management ConsultantConsulting - MarketingConsulting – OperationsConsulting - GeneralEducational ServicesFashionFinance – Financial AnalystFinance – Investment BankerFinance – StockbrokerFinance - GeneralGovernmentHealth CareHospitalityHuman ResourcesInsuraceLawMediaNon-ProfitOffice & Administrative SupportReal EstateSalesTechnology - CodingTechnology – Cyber SecurityTechnology – Help DeskTechnology – Program DevelopmentTechnology – Web DesignTechnology – GeneralOtherEducationWhat is your highest level of education completed?*Please choose an option belowGED/HSE or High School DiplomaAssociates DegreeBachelors degree (US)Bachelors degree (Foreign)Advanced degree (US)Advanced degree (Foreign)Are you currently enrolled in college?*YesNoName of CollegeWhat level of college degree are you pursuing?If you are not pursuing a degree select "Not Applicable"Please choose an option belowNot ApplicableAssociates DegreeBachelors DegreeMasters DegreeOther Advanced DegreeWhat year of college are you currently in?Please choose an option belowNot ApplicableFreshmanSophomoreJuniorSeniorIf you are not currently pursuing a degree select "Not Applicable"If you have a college degree what is the name of the college you graduated from?Have you ever attended a skills training program?*Ex: Per Scholas, STRIVE, Year Up, etcPlease choose an option belowYes, I attended one programYes, I attended multiple programsNoIf yes, which program(s) and when did you attend/graduate?Please include all that you've attendedComputer SkillsDo you have regular access to a computer?*YesNoDo you have regular access to internet?*YesNoMy signature indicates that all information in my application is complete, factually correct, and honestly presented.*Please write your full name, no initials.