Bridges to College & Careers Application Thank you for expressing interest in the Bridges to College & Careers program! Please fill out this short application and take the next step toward your education. If you need help completing this form, please call us at 617-399-3131 or email us at ClientServicesTeam@jvs-boston.org. Client First Name Last Name Mobile Phone Personal Email Mailing Zip/Postal Code Birthdate How can JVS help you?Help to go to school (example: earn a high school diploma, college preparation, or English classes)Job training programs (example: bank career, nursing assistant, food service, hospitality, pharmacy technician, or animal care technician)Help to get a job (example: career coaching, vocational English classes, financial coaching, resume help, or job fairs) Do you currently have a job?YesNo Have you ever had a job before?YesNo Have you ever worked at any job for more than 3 months?YesNo Do you want a full-time job now or after completing the job training?YesNo Are you authorized to work in the United States?YesPrefer not to answer. Do you currently receive any of the following benefits or resources?SNAP (Food Stamps)TAFDC (Cash Assistance)Housing - ShelterHousing - Subsidized (Section 8)ChildcareNone of the above Do you want to receive any of the these benefits or resources in the future? SNAP (Food Stamps) TAFDC (Cash Assistance) Housing - Shelter Housing - Subsidized (Section 8) Childcare None of the above Do you have a High School Diploma or GED/HiSet (from U.S. or other country)?YesNo Do you have a computer or device?I have my own computer or deviceI share a computer or deviceNo, I do not have a computer or device Do you have internet access?YesNo What is your level of experience with a computer?BeginnerIntermediateExpert What country were you born in?Please select... Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Brazil Bulgaria Burkina Faso Burma (Myanmar) Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Congo Costa Rica Croatia Cuba Czechia Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Eritrea Ethiopia Ethopia France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong (China, SAR) Hungary India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Korea Kosovo Kyrgyzstan Laos Latvia Lebanon Liberia Libya Madagascar Malawi Mali Mauritania Mexico Moldova Monaco Montenegro Montserrat Morocco Mozambique Namibia Nepal Netherlands New Zealand Nicaragua Nigeria Norway Other Other - please add comments Pakistan Panama Paraguay Peru Philippines Phillipines Poland Portugal Puerto Rico (USA) Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa Saudi Arabia Senegal Serbia Sierra Leone Singapore Slovakia Somalia South Africa South Sudan Spain Sri Lanka Sudan Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Tibet Togo Trinidad and Tobago Tunisia Turkey Uganda Ukraine United Arab Emirates United Kingdom United States Uzbekistan Venezuela Vietnam Yemen Zambia Primary LanguagePlease select... Afaan Oromo Albanian Amharic Ao Arabic Armenian ASL (American Sign Language) Azeri Bengali Bini Bosnian Bulgarian Burmese Cantonese Cape Verdean Creole Cebuano Chibemba Chinese Croatian Dari Dinka English Farsi French Fulani German Greek Gujarati Haitian Kreyol Hebrew Hindi Hungarian Igbo Italian Japanese Karen Khmer (Cambodian) Kibembe Kinyarwanda Kirundi Korean Krahn Krio Kunama Kurdish Kyrgyz Laotian Lingala Lithuanian Luganda Malay Mandarin Mandingo Mende Mongolian Nepali None Not Disclosed Nuer Other Parsi Pashtu Patois Persian Polish Portuguese Pular Punjabi Romanian Russian Shona Slovak Somali Spanish Swahili Swedish Tagalog Tamil Thai Tibetan Tigrinya Turkish Twi Ukrainian Urdu Vietnamese Wolof Yoruba What is your English language level?BeginnerIntermediateHigh or Fluent Have you ever been a JVS client before?YesNo We have specialized supports for individuals with a documented disability. Do you have a disability that you wish to disclose?YesNo Are you over 17 and under 35?YesNo Are You over 18 and under 24?YesNo Amplifyyesno Contact Information If you need help completing this form, please call us at 617-399-3131 or email us at ClientServicesTeam@jvs-boston.org.