STUDENT APPLICATION
SKILLED FOR LIFE was born in Columbus, Ohio as part of the South Side Neighborhood Leadership Academy. Our project group developed this program out of the belief that we are healthier, more responsible and successful when we grasp and apply the skills necessary to navigate everyday life. We designed the SKILLED FOR LIFE program to target 4 primary skill-sets which we do not feel are currently covered in traditional education curriculum. These areas include Financial, Nutrition, Transportation and Communication. SKILLED FOR LIFE workshops are open to those who are between 16 and 24 years of age, who live on the South Side of Columbus, Ohio. Those interested in participating in the workshops as students should complete the form below. Thank you!
STUDENT'S DATE OF BIRTH
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
1
IS THE STUDENT AT LEAST 18 YEARS OLD OR EMANCIPATED?
*
NO
YES
STUDENT'S NAME
*
First Name
Last Name
STUDENT'S HOME ADDRESS
*
Street Address
Apartment / Unit #
City
State / Province
Zip Code
STUDENT'S CONTACT NUMBER
Format: 000-000-0000.
STUDENT'S E-MAIL ADDRESS
*
Confirmation Email
example@example.com
GUARDIAN'S NAME
*
First Name
Last Name
GUARDIAN'S CONTACT NUMBER
*
Format: 000-000-0000.
GUARDIAN'S E-MAIL ADDRESS
*
Confirmation Email
example@example.com
GUARDIAN'S RELATIONSHIP TO STUDENT
*
CUSTODIAL PARENT
LEGAL GUARDIAN
FOSTER PARENT
Other
CURRENT + COMPLETED EDUCATION
*
CURRENT HIGH SCHOOL STUDENT
SOME HIGH SCHOOL
HIGH SCHOOL GRADUATE / GED
CURRENT COLLEGE STUDENT
SOME COLLEGE
COLLEGE GRADUATE
WHICH WORKSHOPS IS THE STUDENT INTERESTED IN ATTENDING?
*
FINANCIAL
NUTRITION
TRANSPORTATION
COMMUNICATION
CAN THE STUDENT ATTEND 3-HOUR WORKSHOPS ON TUESDAY EVENINGS?
*
ALWAYS
SOMETIMES
NEVER
DOES THE STUDENT NEED TRANSPORTATION TO AND FROM WORKSHOPS?
*
ALWAYS
SOMETIMES
NEVER
DOES THE STUDENT HAVE DIETARY RESTRICTIONS?
*
NO RESTRICTIONS
DAIRY-FREE
GLUTEN-FREE
VEGETARIAN
Other
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PRE-WORKSHOP ASSESSMENTS
These questions will assess the student's current knowledge and interaction in the workshop area(s) they are interested in attending. The student should respond to the questions on this page personally.
FINANCIAL
DO YOU HAVE A CHECKING OR SAVINGS ACCOUNT IN YOUR NAME?
*
NO
YES
DO YOU HAVE A CREDIT CARD IN YOUR NAME?
*
NO
YES
HAVE YOU EVER COMPLETED TAX FORMS FOR A JOB?
*
NO
YES
HAVE YOU EVER FILED A TAX RETURN?
*
NO
YES
DO YOU HAVE STUDENT LOANS FOR COLLEGE?
*
NO
YES
NUTRITION
HOW OFTEN DO YOU COOK MEALS FOR YOURSELF OR OTHERS?
*
OFTEN
SOMETIMES
NEVER
HOW OFTEN DO YOU HANDLE GROCERY SHOPPING FOR YOUR MEALS?
*
OFTEN
SOMETIMES
NEVER
DO YOU MAKE SHOPPING LISTS BEFORE GOING TO THE GROCERY STORE?
*
OFTEN
SOMETIMES
NEVER
HOW OFTEN DO YOU READ NUTRITION LABELS ON FOOD + DRINKS?
*
OFTEN
SOMETIMES
NEVER
HOW OFTEN DO YOU EAT 3 MEALS A DAY?
*
OFTEN
SOMETIMES
NEVER
TRANSPORTATION
ARE YOU A LICENSED DRIVER?
*
I HAVE A DRIVER'S LICENSE
I HAVE A LEARNER'S PERMIT
I DO NOT HAVE A DRIVER'S LICENSE
HOW OFTEN DO YOU USE COTA OR THE CBUS CIRCULATOR?
*
OFTEN
SOMETIMES
NEVER
HOW OFTEN DO YOU RIDE A BIKE OR A SCOOTER?
*
OFTEN
SOMETIMES
NEVER
HOW OFTEN DO YOU WALK TO STORES, SCHOOL OR YOUR JOB?
*
OFTEN
SOMETIMES
NEVER
HOW OFTEN DO YOU USE SERVICES LIKE LYFT OR UBER?
*
OFTEN
SOMETIMES
NEVER
COMMUNICATION
ARE YOU COMFORTABLE COMMUNICATING OVER THE PHONE?
*
OFTEN
SOMETIMES
NEVER
ARE YOU COMFORTABLE COMMUNICATING IN WRITING?
*
OFTEN
SOMETIMES
NEVER
ARE YOU COMFORTABLE COMMUNICATING IN GROUP SETTINGS?
*
OFTEN
SOMETIMES
NEVER
ARE YOU COMFORTABLE WORKING WITH A TEAM?
*
OFTEN
SOMETIMES
NEVER
ARE YOU COMFORTABLE SPEAKING TO A LARGE CROWD?
*
OFTEN
SOMETIMES
NEVER
Submit
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