Job Readiness Training/Youth to Work (Y2W) Internship Application

Step 1 of 3

Name *

First

Last

Preferred Name

Physical Address (no PO Box) *

Address Line 1

Address Line 2

City

State

Zip Code

Are your physical address and mailing address the same? *

What county do you live in? *

Cell Phone Number *

Email *

Birthdate *

Please select your gender *

Do you identify as American Indian? *

Please select your race *

Please select your ethnicity *

Hispanic / Latino
Not Hispanic / Latino

What high school do you attend? *

What is the name of your school district? *

What year will you graduate high school? *

2023
2024
2025
2026

Parent/Guardian Name *

First

Last

Parent/Guardian Cellphone Number *

Parent/Guardian Email *

Photo Release: Please indicate your selection (must be completed by parent or guardian if applicant is under 18 years old) *

I hereby authorize and give full consent to PHOENIX INDIAN CENTER, INC. to reproduce, publish, display and/or copyright all written information, live broadcasts, still or motion photographs/videos and/or voice recordings taken by them or agents, in which the minor listed on this application appears. I release PHOENIX INDIAN CENTER, INC. and its funders, representatives and assignees from any and all claims, demands and causes of action of every nature and kind arising out of or connected with the use of these broadcasts, photographs, videos and/or voice recordings. I further agree that PHOENIX INDIAN CENTER, INC. may use or cause to be used, these items for any and all exhibitions, public display, publications, commercial art and advertising purposes without limitation or reservation or any fee
I do not authorize and give full consent to PHOENIX INDIAN CENTER, INC. to reproduce, publish, display and/or copyright all written information, live broadcasts, still or motion photographs/videos and/or voice recordings taken by them or agents, in which the minor listed on this application appears.

How did you hear about us? *

Are you and/or your household members interested in receiving the COVID-19 vaccination?

The Phoenix Indian Center is able to arrange for you and/or your household members to receive the vaccination.

Select which date you want to attend the Youth Job Readiness Training *

Time: 8:00 AM - 3:30 PM (same time each date). October 29th session will be from 9AM-3PM. Held at the Phoenix Indian Center located at 4520 N Central Ave, Ste 250, Phoenix, AZ 85012. Youth Job Readiness Training is required for the Y2W paid internship program.

Top 3 Career Interests/Areas of Interests:

Name

Job Readiness Training/Youth to Work (Y2W) Internship Application

Technology Access

Work Related Experience

Reference

Education

Student Applicant Acknowledgement

Parent/Guardian Acknowlwdgement