IL Workforce - Give Back

Illinois Workforce Student Interest Form

If this form is prefilled, this box will be checked and some fields will not be shown (HS Info)

Prefilled

Contact ID

IMPORTANT - If you are a current Give Back student, please prefill this form using this link

Student Details

Student First Name

Student Last Name

Student Suffix (ex. Jr., Sr., II, III, IV)

Student Birthdate

IMPORTANT: Your birthdate must be entered as Month/Day/Year (the "/" between each number is very important)!

What state do you currently live in?

Current Grade Level

Prior to August 1st, please enter the grade that you just completed. If after August 1st, please enter the grade that you be entering in the fall.

What year will you (or did you) graduate from High School?

Your current school information

School name:

What city is your school located in?

What state is your school located in?

Please use the two letter abbreviation for your state.

What is your current, weighted GPA?

##.# or #.## (ex. 95.5 or 3.95)

Student Mobile Phone

Our communications tools allow us to send messages through SMS with program updates and invitations. If the student does not have a mobile phone, please enter the primary caregiver's mobile number.

Student Home Phone

If you do not have a home phone number you may leave this space blank

Student Email

Our communications tools allow us to send messages through email with program updates and invitations. If the student does not have an email address, please enter the primary caregiver's email address.

Were you referred to us from one of the individuals/organizations below?

Name of Referring Organization if answer above is "Other or organization is not listed"

Is there a specific person or organization that referred you to us?

Student mailing address

Street

City

Zip Code

Primary Caregiver Contact Details

Primary Caregiver First Name

Primary Caregiver Last Name

Primary Caregiver Mobile Phone

Primary Caregiver Home Phone

Primary Caregiver Email Address

Please answer the following questions:

Do you have access to transportation?

YesNo

Where would be a preferred business location of the two listed below?

AuroraWill County, Illinois (includes Joliet, Shorewood, Plainfield, Lockport, etc)

Are you between the ages of 16-24 years old?

YesNo

Are you eligible to work in the United States?

YesNo

What industry do you have an interest in? Examples: Business, Teaching, Finance, Energy, Medical, Hospitality, Trades.