Generation San Jose CNA

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Student Application

Instructions

This form will take ~45 minutes to complete. Please fill out all required information before submitting your application. If you have any questions during the process email rohit@mckinseysocialinitiative.org or call (415) 937 - 2624.

Personal Information

First Name *

Last Name *

Preferred Name

Gender *

Male

Female

Prefer not to answer

Date of Birth *

To be eligible for the Generation Program, you must be between the ages of 18 and 29.

YYYY

Have you applied before?

Have you applied to Generation San Jose before? *

Yes

Contact Information

Preferred Phone Number *

Please be sure that you enter your phone number correctly. The Generation team may contact you at any point in the application process.

Preferred E-mail Address *

The email address below is the email you supplied when registering for the Generation program. Email is the primary form of communication through the application process. Ensure it is entered correctly.

Current Address

Current Street Address *

City *

State *

ZIP Code *

Back up Contact Information

Who should we contact if we are not able to reach you?
Please provide contact information of a person we can call if we cannot reach you directly.

First and Last Name *

Relationship *

If other relationship, please describe

Phone Number *

More about me

How do you describe yourself? *

Please check the option(s) below that best describes you.

Caucasian or Non-Hispanic White

Hispanic / Latino

African-American or Black

American Indian or Alaska Native

Asian (including Indian sub-continent and Philippines)

Native Hawaiian or other Pacific Island (Original Peoples)

Middle East / North African

Prefer not to answer

Required

What is the highest level of education you have achieved? *

High School or GED

Some vocational training beyond High School (no certificate or credential achieved)

Completed vocational training certificate or credential

Some higher education

Completed two year or associate degree

Completed a four year degree (bachelor's)

Other:

How did you hear about the Generation program? *

My School

Friend / Family Member

Social Media

Community Organization

Other:

Required

Enter the name of the school you attended *

What makes you a good fit for the Generation program? *

Please describe in 250 words or less.

What do you consider your biggest strengths? *

Please describe in 250 words or less.

What is your monthly income? *

Are you currently accepting government assistance? *

Yes

Do you have children? *

Yes

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