Youth@Work/SYEP Corporate Interest Form

Name of Organization

Point of Contact

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Phone Number

Tax ID Number

Type of Organization

Number of Positions Available

Located in County

Yes

No

Notes

Work Sites

Please provide information on various work site(s) that youth may be assigned, if available.

Primary Worksite

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Number of Positions

Brief Description of Type of Work to Be Assigned

Secondary Worksite

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Number of Positions

Brief Description of Type of Work to Be Assigned

Youth Qualifications

Please provide information on preferred qualifications/skills/age of youth assigned to each site, if available.

Preferred Age Range

Total Number of Youth Your Agency Can Accommodate

Preferred Skills