Participant Profile - Woodward Career Tech MY - Cincinnati Youth Collaborative

Participant Profile - Woodward Career Tech MY

First Name

Middle Name/Initial

Last Name

Nickname

Current Photo

Street Address

Apt/Suit/Other

City

State

Zip

Email Address

Home Phone

Mobile Phone

Work Phone

Ext.

Birthdate

Gender

Race

Please provide information for someone who should always be able to contact you, in case we lose contact with you.

Relationship

First Name

Last Name

Street Address

Apt/Suite/Other

City

State

Zip

Home Phone

Mobile Phone

Work Phone

Ext.

Email Address

Let us know where you are currently enrolled and what plans you have for the future.

Date

School

Grade in School

School ID

Other ID

Class Standing

Cumulative GPA

Credits Toward High School Graduation

Credits Required for High School Graduation

Absences Last School Year

If you selected Attend a four-year college or Attend a two-year college please tell us your major:

If Other:

Are you currently employed?

Employment

Most Recent Employer

Employer

Job Title

Hours Per Week

Hourly Wage

Employment Date

Are you currently enrolled, or plan to be enrolled, in any training programs?

Occupational Training

School or Organization

Program

Current Living Situation

Number in Family/Household (including yourself)

Mother/First Parent's Education

Father/Second Parent's Education

If you live with your Mother/First Parent, is he/she currently employed?

If you live with your Father/Second Parent, is he/she currently employed?

Free/Subsidized Lunches

Government Assistance (check all that apply)

Welfare (TANF) Public Assistance Supplemental Security Income Other cash income from the government not including retirement benefits No government assistance

Barriers

A1 - One or more modal grades behind peers

Number of Grades

A2 - Has repeated a grade in school A3 - Low academic performance A4 - Basic skills deficient (reading and math in particular) A5 - Limited English proficiency A6 - Did not pass the state proficiency exam

A7 - A past record of excessive absences as verified by school officials A8 - Has been suspended, expelled, or put on probation during high school A9 - Has dropped out of school previously

High School Attended

Last Grade Level Completed

Offense

E11 - Has a record of violent behavior E12 - Homeless

Number of Residences in Past Year

E13 - Runaway E14 - Requires child care during work or school E15 - Needs transportation to and from work or school E16 - Foster Care

Number of Placements in Past Year

Explain

P1 - Special education certified P2 - Lacks motivation or maturity to pursue education or career goals P3 - Emotional disorder which impairs education or career goals P4 - Has a disability

Disability

P5 - Health problems which impair education or career goals W1 - Economically disadvantaged as defined by public assistance, TANF, or free lunch W2 - Having inadequate or no work experience W3 - Lacks marketable occupational skills that are in demand in the local labor market W4 - Has been temporarily or permanently laid off or have had hours reduced due to the 2020 Corona Virus Pandemic. W5 - Has a Parent/Guardian/Supporting Adult who has been temporarily or permanently laid off or have had hours reduced due to the 2020 Corona Virus Pandemic.