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First Name
Program Intake Form
Last Name
Date of Birth
Email Address
Phone
Available Start Date
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Link to Your Resume
City of Residence
Current Education Status:
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Required
Currently enrolled in high school
Enrolled in alternative education program
High school graduate / GED
Enrolled in college or vocational training
Not currently enrolled in school
Current Employment Status:
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Required
Employed full-time
Employed part-time
Unemployed
Actively seeking employment
Not currently seeking employment
What type of support are you seeking? (select all that apply):
Job readiness / workforce preparation
Resume building
Interview preparation
Career exploration / goal setting
Job placement assistance
Work experience / internship opportunities
Mentoring or coaching
Support navigating barriers to employment
Barriers to Employment (Optional) Please select any that apply:
Housing instability or homelessness
Financial hardship
Limited work experience
Limited education or training
Justice system involvement
Foster care involvement (current or former)
Disability (learning, physical, or mental health-related)
Parenting or caregiving responsibilities
I understand that submitting this form does not guarantee program placement. I consent to be contacted by Beauty Out of Ashes regarding services, resources, and referrals.
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