Student Application Please enable JavaScript in your browser to complete this form.Section 1: Tell us about you:Full Name: *Address:LayoutPhone:EmailLayoutGenderMaleFemaleAgeLevel of Education completed (check all that apply):FreshmanSophomoreJuniorSeniorCollegeGEDList any other areas of completed education such as Trade School, Community College courses?Section 2: Tell us about your challengesPlease share with us anything you feel has made it harder for you to STEP OUT (Step 2)…To STEP INTO DESTINY (Step 3); For example: A felony, single mom/parent home, depression, bullying, etc.Section 3: Where do you see yourself in five years?Name one or two goals for your emotional well-being (write as many as necessary) Happy / Stress-free / Financially stable, etc.My Educational Goal (s) for the next 5 years (check all that apply):Finish High SchoolComplete a Trade SchoolGet a Technical college degreeObtain a Bachelor’s degreeOther goals:In my spare time, I like to:My dream career is to be:For example : - A hair stylist, A lawyer, An artist, An engineer, An architect, A professional athlete - Start my own business (entrepreneur) - Other (Write on back if necessary)What type of Community Project do you believe would help improve the areas around Monroeville, Pitcairn, and Homestead?Why would connecting with a youth in Kenya be exciting for you?I believe that I am eligible for this program and the information I have provided in this application was entirely accurate to the best of my knowledge at the time I completed it. *I agreeLayoutPrint NameSignatureClear SignatureIf you are under 18, you must obtain a Parental (Guardian) Consent Form (separate from application). click here to open the consent formTHANK YOU for applying to the 3STEPS2WORK Dynamic Dozen Program. We’re so happy that you’re joining us on this journey!Confidentiality and Disclaimer of Liability:All information related to this application is held in strictest confidence and will be used for the express purpose of WDGA’s program (s) selection process. With respect to documents and processing, neither WDGA nor any of its employees, contractors, or volunteers assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of any information, or process disclosed, or represents that its use would not infringe privately owned rights.Submit
