SCI Application Page — Your Site Title

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Are you looking to gain a new start and develop skills that will open up employment opportunities?

Apply to be a part of our program and take a step towards a brighter future.

Section 1: Personal Information

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of birth

YYYY

Section 2: Education and Employment History (please note, your answers to the following questions are just to help us get a better idea of what you may need if accepted and do not impact you negatively).

What is your highest level of education?

(please note, your answers to the following questions are just to help us get a better idea of what you may need if accepted and do not impact you negatively).

Are you currently employed?

(please note, your answers to the following questions are just to help us get a better idea of what you may need if accepted and do not impact you negatively).

Yes

If yes, current employer and role:

Previous employment history

Please select the services you are interested in.

Personalized job training programs

Life Skills Education:

One-on-One Counseling

Career Guidance and Job Placement Assistance

Section 3: Adversity Faced

Please describe any adversity or challenges you have faced.

In this section, we ask you to describe any adversity or challenges you have faced that you feel comfortable sharing, and tell us why you think you deserve to be accepted into the Second Chance Initiative. This information is confidential and is only used to help us better understand your background and needs. (Please limit your answer to a few sentences.)

Section 4: The Future You Envision

Tell us about the future you envision for yourself.

In this section, we'd like you to tell us about your aspirations. What kind of employment are you looking for? What goals do you have for your future? (Please limit your answer to a few sentences.)

Please note, submission of an application does not guarantee acceptance into this program. We are a small team and unfortunately do not have the capacity to accept everyone that submits an application.

Application

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