YouthBuild Application

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Contact Information




mm/dd/yyyy















Demographic Information






Check all that apply. Please check the "Not Applicable" box if you do need any special accommodations.









Please select "Not Applicable" if this does not apply to you.


Youth Questions








If you have NOT worked for the same employer more than 3 months, please select "Yes"
Household and Family Info

Please enter your annual household income. Your best estimate will suffice.
You should include/count yourself in only one of these categories in addition to other household members.
You should include/count yourself in only one of these categories in addition to other household members.
You should include/count yourself in only one of these categories in addition to other household members.
If interested: We offer financial coaching & help individuals open a checking and/or savings account, who don't currently have a checking / savings account. 


Emergency Contact Information





Public Assistance Benefits
Are you currently receiving any of the following forms of public assistance?
Employment History

In the next section, please fill in information about your most recent job or current job, if applicable. 











Education History







Military Status




Justice Involvement

Crime Details

Thank you for showing interest in SER-Jobs for Progress. SER works with both minors and adults and is therefore unable to serve sex-offenders. We encourage you to reach out to the resources below.

 

Work Faith Connection - a partner agency focusing on job readiness skills, click on the link to learn more: http://workfaithconnection.org/.

 

United Way of Greater Houston - offering a hotline that can be accessed 24/7 by dialing 211. The live operator will provide you a list of additional community agencies that can help you or you may visit their website for more information: https://www.unitedwayhouston.org/our-211-helpline/.

 

Thank you again for your time, have a nice day.


Check all that apply






Total time 
incarcerated?




Virtual (Online) Training






Covid-19
Due to the constant changes of Covid-19 YouthBuild requires that all participants be fully vaccinated and be able to provide proof. 

Essay Question

Services you are seeking

Please rate the three services that you are most interested in below:




Check all that apply


Check all that apply

Check all that apply


Minimum hourly rate


One of our YouthBuild Staff members will contact you during our scheduled hours of operation (Monday – Friday, 8AM – 4PM), to discuss next steps towards enrolling in YouthBuild Houston. Our office number is 713-773-6000.