MyCITY 2Gen Application
Adult Applicant Information
Adult First Name (as listed on birth certificate)
Adult Last Name (as listed on birth certificate)
Adult Middle Name (as listed on birth certificate)
Suffix (Jr., II, III)
What name would you like to be called?
Gender Identity
Please select...
Man
Woman
Non-Binary
I prefer to self-identify
I decline to state
Pronouns
Please select...
She/Her/Hers
He/Him/His
They/Them/Theirs
Other
Prefer Not To Answer
Pronouns
Race
Please select...
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latinx
Native Hawaiian or Other Pacific Islander
White
Multi-Racial
Other
Do not know
Prefer not to answer
Ethnicity
Please select...
Hispanic or Latinx
Non-Hispanic or Latinx
Arab
Do not know
None of the above
Prefer not to answer
Date of Birth
Applicant Email Address
Confirm Applicant Email Address
Applicant Email Doesn't Match Message
Applicant Phone Number
Please enter without any spaces, dashes or symbols.
Applicant Alternate Phone Number
Address
Street Address
Address Line 2
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Zip Code
Which neighborhood do you live in?
Please select...
Burke Acres
Colony Farm
Eastside
Edison
Hill N’ Brook
Knollwood
Milwood
Northside
Oakland/Winchell
Oakwood
South Westnedge
Southside
Stuart
Vine
Westnedge Hill
Westwood
Do Not Know
Youth Information
Age of all youth in your home
Has a youth in your household participated in programming at YOU in the past?
Yes
No
Unsure
Name of youth who would complete the program with you
Relationship to the young person (e.g. child, niece, nephew, etc)
Are there other adults in your household interested in receiving career-related support? If so, list their name(s).
Youth Date of Birth
Youth Email Address
Youth Name #2
Youth Date of Birth #2
Youth Email Address #2
Educational Information
What is your highest level of education?
Please select...
Some high school
High school diploma or GED
Completion of trade school
Certificate
Some college
Associate's degree
Bachelor's degree or above
In which of the following areas are you interested in receiving support?: (choose all that apply)
Earning a GED
Earning a certificate
Enrolling in a short-term training program
Enrolling in an associate's degree program
Enrolling in a bachelor's degree program
Enrolling in a graduate degree program
Changing/finding a new career path
Finding employment
Advancing in my current line of work
Financial planning support
Parenting guidance/assistance
Transportation to sessions
Childcare for younger children
Barriers related to physical/mental health
Unsure
None of these
Other
If you chose "Other" please specify:
How did you hear about the MyCITY 2Gen program?
Please select...
Email
Flyer
Facebook or other social media
Family/Friend
Community/neighborhood organization
Michigan Works! Southwest
YOU/MyCITY
My child's school
Kalamazoo Literacy Council
Other
What motivates you to want to be part of the MyCITY 2Gen program?
What are you hoping that you and the young person that is applying for MyCITY 2Gen will learn together through these programs?
Hidden Fields
Lead ID
Contact ID
YOU RT ID
Student RT ID
Guardian RT ID
Application Owner ID
Contact Information