Complete and return this STEP Application ASAP to

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:
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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: ___________________________________________________________________________________
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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:_________________________________________________________
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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:________________________________________________________
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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):
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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
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www.pcfwd.org
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