YouthBuild Application

Applicant Information

First Name

Middle Name

Last Name

Street

City

State

Zip Code

Mobile Phone

Home Phone

Preferred Phone

Email Address

If someone referred you to Tree Trust, please write their name:

Birthdate

Gender

Ethnicity (Hispanic/Latino)

What is the last Grade Level you completed in School?

If attend school, what school do you attend?

Are you currently employed?

Emergency Contact Information

Emergency Contact #1 Name

Emergency Contact #1 Phone Number

Emergency Contact #1 Relationship

Emergency Contact #2 Name

Emergency Contact #2 Phone Number

Emergency Contact #2 Relationship

At Risk Information

Funds for this program are targeted to serve youth who have a disability or qualify as low-income or at-risk.

Do you or did you have an Individual Education Plan (IEP) at school?

Are you a youth in foster care or aging out of foster care?

Do you have a parent who is currently in jail or prison?

Are you currently a teen parent or pregnant?

Are you currently homeless?

Have you ever been convicted of a crime?

If you've been convicted, was it a ...

Were you convicted as a ...

Are you currently on parole?

Income Information

This information in needed to determine your eligibility.
Do you and/or your parent or guardian receive any of the following types of assistance?

SSI (this must be for the applicant only - not any other member of the family)

Free School Lunch Eligible (must be free, not discounted)

TANF (Temporary Assistance for Needy Families)

MFIP (MN Family Investment Program)

TANF or MFIP yes

TANF and MFIP no

General Assistance

Food Stamps

Family Information

Including yourself, how many people, related to your by blood, marriage, or adoption have lived in the same household in the past 6 months?

For the questions below include as income: gross wages, net self-employment income, alimony, Social Security benefits, rental property income, pensions, dividends, interest on savings, training stipends, grants (excluding Pell Grants), railroad retirement benefits, strike benefits, net gambling or lottery winnings. DO NOT include as income: any form of public assistance, Supplemental Security Income, unemployment compensation, child support received, loans, one-time gifts, lump-sum inheritances, withdrawals from savings account, tax refunds, one-time insurance payments or compensation for injury, payments made on behalf of a foster child, the sale of property, HUD rental assistance programs.

Applicant's Annual Income

Additional Income from other Family Members

Do not include your income in this number

I am over Age 18 and my own Legal Guardian

YesNo

Please provide an email address for your Parent/Guardian:

CONSENT TO SHARE WAGE AND EMPLOYMENT INFORMATION

I give permission for the Department of Employment and Economic (DEED) unemployment Insurance Division (UI) to release information in the way described on this form. The specific data or types(s) of data that DEED Unemployment Insurance Division may release are wage and employment records. I agree to let DEED UI release these data to the Workforce Center System for up to three years. I understand that YouthBuild program staff needs to collect the data in order to determine outcomes for YouthBuild programs. I understand that, whether or not these data are released to YouthBuild Program staff will not affect my participation in the YouthBuild program. *If you are under 18 years of age or not your own legal guardian your legal guardian will verify this consent in the e-signature forms that will come after this application received.

I agree to the sharing of wage and employment information

After submitting your application you will receive an email with forms that need to be signed either by you (if you are over 18 and your own legal guardian), or by you and your legal guardian. If you do not receive that email with 24 hours please contact our office. Please click SUBMIT below to complete this portion of your application.