Youth Development Program Application

ALL APPLICANTS MUST HAVE A MINIMUM OF A 2.50 GPA AND HAVE COMPLETED 9th GRADE OR ABOVE IN ORDER TO APPLY

Applicant Last Name*

First Name*

Middle Initial*

Application Date*

Home Address*

Street Address City State ZIP

Applicant Cell Phone*

Home Phone*

Applicant Email Address*

Date of Birth*

Age*

Gender*

Male
Female

Applicant Race: (Please select one)*

White/Caucasian
Black/African American
Native American
Asian American
Hispanic/Non-White
Other

Parent/Guardian Last Name*

Parent/Guardian First Name*

Parent/Guardian Email Address*

Parent/Guardian Contact Phone Number*

Please select one answer for the following (2) questions:

Educational Status*

(If not in high school please STOP. Do not complete this application)

9th-10th
10th-11th
11th-12th

Do you have a minimum of 2.50 GPA or higher?*

(If yes, please continue the application)

Yes
No

Name of High School*

Highest Grade Completed*

GPA*

The following information will help us determine eligibility for the POC Summer Youth Training and Employment Program

Have you ever been arrested/pending charges?*

(Background Checks Mandatory)

Yes
No

Total family annual income (gross)*

(Proof of income must be provided)

Number of members in your household*

Attach latest report card*

Max. file size: 64 MB.

Attach proof of income documentation*

Max. file size: 64 MB.

Release of Information
I hereby authorize representatives of the POC Youth Development Program to obtain information concerning my household member’s income, ID and Security numbers for the purposes of determining eligibility. (ALL INFORMATION WILL REMAIN CONFIDENTIAL)

APPLICANT SIGNATURE*

DATE*

PARENT/GUARDIAN SIGNATURE*

Date*

Completion of this application does not guarantee a position. Incomplete application will be discarded.
If you have any questions, please call (727) 823-4101 ext. 115 or ext. 110
APPLICATION DEADLINE: February 7, 2025
VIRTUAL EDUCATION PROGRAM: FEB. 19 - MAY 14, 2025 SUMMER WORK PROGRAM DATES: JUNE 9 - JULY 18, 2025

RETURN THIS FORM, MOST RECENT REPORT CARD AND INCOME DOCUMENTATION TO:
Pinellas Opportunity Council, Inc.
501 1st Avenue North, Suite 517
St. Petersburg, FL 33701

2025 Youth Development Program Application