Young Adult Program Application & Initial Assessment

Name(Required)
Address(Required)
Mobile or Landline?(Required)
Email(Required)
MM slash DD slash YYYY
Pronouns(Required)
Mark all that apply
Gender Identity(Required)
Mark all that apply.
Sexual Orientation(Required)
Mark all that apply
Race/ Ethnicity(Required)
Click All That apply.
Disability Status(Required)
Check All That Apply.
Living Situation(Required)
Human Services To Which You Have Been Connected(Required)
Level of Education Completed(Required)
Are You Currently In School?(Required)
Have You Completed a GED?(Required)
Employment(Required)
If you prefer not to disclose, please type "Prefer Not To Say"
Food Security(Required)
Health Insurance Status(Required)
Health Care System Service Usage(Required)
What is Your Support System(Required)
Check All That Apply

Assessment

LGBTQ+ Knowledge

Do you understand what gender identity is?(Required)
Do you understand what sexual orientation is?(Required)
Are you knowledgeable about LGBTQ identities and the people in the community?(Required)
Are you knowledgeable about the issues surrounding the LGBTQ identifying people of color?(Required)
Do you understand what intersectionality is?(Required)
Are you knowledgeable about different cultures surrounding the LGBTQ community?(Required)
Do you understand what gender expression is?(Required)

School & Employment

Have you ever made a resume?(Required)
Have you ever filled out a job application?(Required)
Do you have a resume that you are confident with using?(Required)
Have you ever completed a job interview?(Required)
Have you considered attending college/university or vocational school?(Required)
Do you know what a FAFSA form is?(Required)
Do you know how to fill out and locate a FAFSA form?(Required)

Finances

Do you know how to open a bank account?(Required)
Are you familiar with ways to save money?(Required)
Are you familiar with filling your taxes each year?(Required)
Do you know how to identify scammers?(Required)
Do you know how credit ratings work?(Required)
Do you know how to create emergency funds for when you need it in the future?(Required)

Life Skills

Do you know how to locate the nearest hospital to your home?(Required)
Are you able to identify at least 3 ways to keep yourself safe when living independently(Required)
Do you know how to plant produce indoor or outdoor?(Required)
Do you know how to do basic car repairs such as changing tires, oil checking car fluids?(Required)

Race Biases

Do you know the definition and meaning of “implicit bias”?(Required)
Do you know what systemic oppression is and how it affects people of color?(Required)
Do you know what the definition of “intersectionality”?(Required)
Are you aware of how privilege and lack having thereof affects different people?(Required)
Do you know how we hold stereotypes of different people and how that affects people of color?(Required)

How Did You Learn About The Center on Colfax?(Required)

Would you like to join Saga's Discord Server?(Required)