California PAL Youth Apprenticeship Readiness Accelerator Santa Paula/Santa Barbara County Program Application Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Applicants Full Legal Name *FirstMiddleLastAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeLayoutDate of Birth *Age *Cell Phone # *Gender *- Please Select -MaleFemaleNon-BinarySocial Security Number *Please enter numbers only - no dashes or spaces.2nd Phone # (Home or other)Email *Demographic & Personal InformationThe California PAL YARA Program applicants that are selected for the program will be recipients of various scholarship funding dollars from multiple federal/state and private sources. Applicants are required to solicit certain demographic and economic information such as household income to meet reporting requirements. Applications must provide this requested information voluntarily in order to qualify for the YARA program. This information will be kept confidential and will not be utilized in a discriminatory manner.Do you have a valid CA Drivers License? *YesNoYou must have a valid government issued photo ID to be accepted into the apprenticeship program, you do not need one to apply. Examples: Driver’s License, Passport, Green Card, State ID, Military ID, Tribal DocumentsLayoutNation of Citizenship- Please Select -AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsPlease indicate the gross income of your household/residence for the most recent year. Include both taxed and untaxed income. (If you are a minor, please indicate your parents household income) *- Please select -Less than $10,000$10,000-$19,999$20,000-$39,999$40,000-$59,999$60,000-$79,999$80,000 or moreWhat is your Shirt Size?What is your Shoe Size?Race / Origin *- Please Select -American Indian or Native AlaskanAsian or Pacific IslanderBlack (not of Hispanic origin)Hispanic (a person of Mexican, Puerto Rican, Cuban, South Central American or other Spanish culture or origin, regardless of race.)White (not of Hispanic Origin)Bi-RacialMulti-RacialWhat is your current education level?Still attending High SchoolHigh School GraduateGEDNo GED or HS DiplomaAttending CollegeCollege GraduateDo you have any Allergies or special medical needs?Have you ever been convicted of a felony? If so, when?Are you currently on probation or parole?High School InformationIf you are between the ages of 16 - 19 yrs and are still attending high school, please fill out the information in this section. LayoutHigh School Type?Public High SchoolPrivate/Charter SchoolHome SchoolContinuation SchoolHigh School NameCurrent Grade Level?9th Grade10th Grade11th Grade12th GradeExpected High School Graduation DateParent/Guardian InformationOnly minor applicants between the ages of 16-18 are required to fill out this section. If you are over age 18 you do not need to provide this information.Fathers NameFirstLastLayoutFather or Legal Guardian OccupationFather's Phone #Father or Legal Guardian Education- Please select -High School or LessTrade or Vocational SchoolSome CollegeUndergraduate College DegreeGraduate DegreeFather's EmailMothers NameFirstLastLayoutMother or Legal Guardian OccupationMother's PhoneMother or Legal Guardian Education- Please select -High School or LessTrade or Vocational SchoolSome CollegeUndergraduate College DegreeGraduate DegreeMother's EmailYARA Applicant InformationDo you have or are you covered by a Medical Insurance plan? *Yes, I am covered through my parents medical plan.Yes, I am covered through my own medical insurance plan.NoOtherMedical Insurance Company / Provider:Do you have family obligations that would possibly keep you from participating in YARA program training or job site activities? *Yes, I have to work to supplement family incomeYes, I provide primary care for family member(s)NoOtherIf yes or other, please describeHow did you hear about the YARA program?AgreementI understand that this application is for possible selection only into the California PAL Youth Apprenticeship Readiness Accelerator program. I agree that I am bound by the program selection regulations and admission requirements. I agree to the release of any personal information between California PAL, LiUNA and any of the other partner & sponsor organizations that are providing resources, funding or training within the YARA program. I certify that this information is complete and accurate. I understand that making false or fraudulent statements within this application or residency statement will result in denial of admission and invalidation within the YARA program. If selected for the YARA program, I agree to abide by the policies and procedures of the program as required by the California Police Activities League, LiUNA and any of the other additional sponsors, program partners or funders. Should any information change prior to my selection into the YARA program, I will notify the program administrator at info@calpal.org. Do you understand and agree to the terms listed above? *Yes, I understand and agree to the terms listed above.Applicant Name *FirstLastApplicant SignatureClear SignatureParagraph TextSubmit
