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SYEP Application

SYEP Application

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Published by SLJ Summer

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Published by: SLJ Summer on Apr 07, 2008
Copyright:Attribution Non-commercial

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12/06/2012

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The Summer Youth Employment Program (SYEP) offers work experience, teachesvaluable employment skills, and provides you with a summer income. SYEP educationalactivities will enhance your summer experience, allowing you to develop career awareness,understanding of personal money management, and work-related social skills.SYEP is open to all New York City residents between ages 14 through 21, as of July 12008, regardless of family income level. If you are a male 18 years of age or older, to beeligible to participate in SYEP you must be registered with the Selective Service System.
 
Each applicant may submit only one application.
To apply for SYEP:
 
Visit
www.nyc.gov/dycd
and complete the application online.
OR
 
 
Complete the attached application and return it to the community-based SYEP providerof your choice (a list of organizations throughout the City is attached).The
DEADLINE
for submitting your application is
Friday, May 16, 2008
.
SUBMISSION OF AN APPLICATION DOES NOT GUARANTEE ELIGIBILITY ORPLACEMENT INTO THE PROGRAM.
 
Completed applications will be entered into a lottery to determine those applicantswho will be offered a position in SYEP.
 
Enrollment into SYEP is subject to the verification of the information that youprovide.For more information or if you have questions about completing this form or the requireddocuments, please call 311 or 1.800.246.4646 and ask about SYEP.
The status of your application can be found atwww.nyc.gov/dycd 
 
(Turn over to next side)
 
City of New YorkDepartment of Youth and Community Development
2008 Summer Youth Employment Program
Michael R. BloombergMayor
 
APPLICATION INSTRUCTIONS
Jeanne B. MullgravCommissioner
 
 
If you are selected for SYEP
 
you will be notified by the SYEP provider to which yousubmitted your application and asked to submit additional documentationimmediately (
see attached
 Required Documents Checklist 
)
Failure to submit required documentation as instructed will make you ineligible toparticipate in SYEP.
 
 
One application will be accepted for each applicant. Completed applications will be entered into a lottery to determine those applicantswho will be offered a position in the Summer Youth Employment Program. SUBMISSION OF AN APPLICATION DOES NOTGUARANTEE ELIGIBILITY OR PLACEMENT INTO THE PROGRAM.1
. Social Security Number- -
2.
Gender
(Check one)
Male Female
3
. Last Name
4
. First Name
5.
Middle
 Month Day Year
6
.BirthDate
7.
Citizenship Status
(Check one)
 U.S. CitizenPermanentResident AlienOther
8
. Street Address
(number and street)
9.
Apt #
10.
Zip Code
 
11
. Borough
(Check one)
 
Bronx
 
Brooklyn
 
Manhattan
 
Queens
 
Staten Island
 
12
.
Email AddressLast Name First Name
13
.
Name of Parent orLegal Guardian
(Area code) (Area code)
14
.
 
Phone Number
 
-
-
15.
 
Emergency ContactPhone Number- -
16.
 
Ethnicity
 
American Indian
 
Asian (Non-Hispanic)
 
Black (Non-Hispanic)
 
Hispanic/Latino
(Check One)
 
Pacific Islander
 
White (Non – Hispanic)
 
Other
17.
Current educationalstatus
Student in HS orbelowCollege student HS graduate GED recipientLeft HS beforegraduating
18
.
 
Current grade if in HighSchool or below
 19.
 If not in HS, lastgrade completed
20
.If applicant is a male 18 and over, ishe registered with Selective Service?Yes No
21
. Check here if the applicant has a disability
 
22.
Is applicant currently in the foster care system?
 
Yes
 
No
 23.
 
Is applicant or applicant’s family currently receivingpublic assistance?
 Yes
 
No
If No, proceed to question 25.
24
.Type of Public Assistance
(Check all that apply)
 
Family Assistance (formerlyknown as AFDC)Food Stamps S.S.I. Safety Net/HomeRelief Other
25
.Total family income (gross) for the prior calendar year $
26.
Number of family members currently living in applicant’s household
27.
 Is the applicant or any member of the household (0-64 years of age) covered by Medicaid, Child Health Plus, FamilyHealth Plus or private medical insurance?
Yes
 
No
 
CERTIFICATION STATEMENT
I, the undersigned, certify that all information on this form is true and correct. I understand that my statements are subject to verification. I furtherunderstand that any false statements may subject me to criminal prosecution under both New York State Penal Laws, section 175.35 and Federal Law, 18U.S.C.A. 1001, and to civil action for return of all monies received. I agree and accept that I will abide by all applicable rules and regulations of thisprogram.Applicant Signature Date Parent/Guardian Signature Date
(Required if applicant is under 18 years of age)
Intake Officer Signature Date
The status of your application can be found atwww.nyc.gov/dycd  
City of New YorkDepartment of Youth and Community Development
2008 Summer Youth Employment Program
Michael R. BloombergMayor
 
APPLICATION
Jeanne B. MullgravCommissioner
 
28.
 If NO, do you want to be contacted with information about public health insurance programs?
Yes
 
No
 

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