I am interested in applying for:
*
Check all that apply.
Date
MM
DD
YYYY
Name
First Name
Last Name
Email
*
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Other Number
(###)
###
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Nation of Citizenship
Race/Ethnicity
African American, African, Afro-Caribbean or Black
Native American or Alaskan Native
Asian American or East Asian
Latinx/Hispanic or Chicanx
Native Hawaiian or Pacific Islander
Caucasian/White
Multi-Racial
N/A
Native Language
Additional Languages You Speak
Please list any additional languages that you can speak here separated by a comma.
Gender Identity
Female
Male
Transgender
Non-binary
Gender Neutral
Are you a veteran of the U.S. Military?
Date of Birth
MM
DD
YYYY
How did you hear about the YWeb Career Academy.
*
Please any and all sources that you may have found out about the YWeb through.
What do you feel makes you a good candidate of the YWeb Career Academy?
*
Please give a brief description of the reasons you feel make you good choice for acceptance into the program. How do you think you benefit from being in a program like YWeb.
Talents and Awards:
*
List each, a description, the level, and the number of years of involvement.
Community Service Work:
List the type of work, your role, and hours per week of involvement.
Employment:
List the job, your title, description, hours per week, and dates of employment.
Are you currently employed?
*
If YES, please check:
Do you currently have your own computer?
*
What is the Make and Model of your computer?
*
Is person who files Head of Household a women/female (she, her, hers)
*
Total number of people in your household:
Total number of people in your household:
Please indicate your family’s gross income for the most recent tax year. Include both taxed and untaxed income.
*
Less than 20,000
$20,000 - $39,999
$40,000 - $59,999
$60,000 - $79,999
$80,000 or more
Do you have family obligations that keep you from participating in extracurricular activities?
If yes or other, please describe:
City and Country of Birth
What is the status of your VISA?
I currently hold one.
I am applying for one.
What type of VISA?
F2
J1
J2
None
Other
If other:
I understand that this application is for admission only for the term indicated. I agree that I am bound by YWCA Madison's regulations concerning application deadlines and admission requirements. I agree to the release of any transcripts and test scores to this institution, including any SAT, Achievement Test, and ACT score reports. 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 disciplinary action, denial of admission and invalidation of credit or certificates earned. If admitted, I agree to abide by the policies of the YWeb and the rules and regulations of YWCA Madison. Should any information change prior to my entry into YWeb, I will notify YWCA Madison.
Events, activities, programs, and facilities of the YWeb Career Academy are available to all without regard to race, color, marital status, sex, religion, national origin, disability, age, Vietnam or disabled veteran status as provided by law and in accordance with YWCA Madison’s respect for personal dignity.
