OEP Interest / Referral Form

Looking for a fresh start? This is the program for you!

Welcome to Madison Park Development Corporation's

Opportunity Employment Program (OEP)

MPDC's successful leadership and job training programs offers opportunities for individuals to experience the world of work while attaining skills and knowledge to help prepare them for future meaningful employment. The Opportunity Employment Program serves court-involved, out-of-school and unemployed people ages 16 to 24 pursuing HiSET completion.

We provide services based on the need of our clients and will work together with them to complete personal goals identified during their engagement with our program. It is our hope that through this program we are able to propel our clients into a successful future as well as combat the many barriers our community faces (such as gun violence, substance abuse and addiction to name a couple) on a day to day basis, in hopes to give our communities a better chance at becoming more stable and vibrant.

Please fill in the form completely and carefully. Please do not leave any blank spaces. Incomplete forms will not be accepted. If you have questions about completing this form please email Sandra Sierra at SSIERRA@MADISON-PARK.ORG

In addition to completing this form, contacts should be prepared to submit the following documents at the time of their scheduled intake:

A valid copy of their social security card is preferred to participate in the program. If they do not have a social security card, please have them apply for a card at 10 Malcolm X Blvd, Roxbury, MA 02119. Hours: Mon-Tues, Thurs-Fri. 9am-3pm and Wed. 9am-12pm. For more info please call 1-800-772-1213 or go to www.ssa.gov. This is not mandatory at this time but strongly suggested.
A copy of your photo I.D. (i.e., driver's license, state issued I.D., passport)

All information provided will be kept confidential and used only for the purposes of facilitating employment opportunities.

Thank you,

Sandra Sierra, Opportunity Employment Program Manager

Carlos Taveras, Opportunity Employment Program Coordinator

Arianna Guiseppone, LMHC, Licensed Clinical Manager

Referred By

Name

Agency

Phone

Is client aware of this referral

YesNo

Contact Information

(Please fill in the following information)

Last Name

First Name

Date of Birth (MM/DD/YY)

Please be sure to enter birthdate in the format listed (mm/dd/yy)

Gender

Address (include unit number)

State

City

Zip

Primary Phone

Email Address

Parent/Guardian (if under18)

Parent/Guardian Telephone

Parent/Guardian Email Address

What is client's primary language?

If multilingual, what is client's secondary language?

Please click "SUBMIT" and your application will be transmitted to Madison Park Development Corporation's Opportunity Employment Program.
Thank you.

MPDC OEP Interest Form