Economic Empowerment Institute Online Application

  Welcome to YWCA Metropolitan Chicago’s Economic Empowerment Institute! We are committed to helping you along the path of economic empowerment. We offer a range of programs and services. To get you to the right program, please check the box or boxes below so we know how we can best serve you. There are ten sections in total to complete, so please make sure to allocate the full time needed as you can't save your progress.


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Question - Required - What assistance are you looking for?
Please make between 1 and 5 selections from the choices below.

   


 
Question - Not Required - What other services are you interested in learning more about?

  SECTION I. CONTACT INFORMATION

  Please complete all fields below

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Name:

 

 

   

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City/State/ZIP:

 

    

 

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Date of Birth:

 

If you respond and have not already registered, you will receive periodic updates and communications from YWCA Metropolitan Chicago.


  SECTION II. DEMOGRAPHIC INFORMATION

Our program funders require us to collect certain demographic information. In addition, some of our programs have income, age, gender and geographic restrictions. We are also expected to reach certain target populations, like survivors of domestic violence, people at risk for homelessness, or returning citizens. The information you share with us is confidential. It will only be used to help you access services, improve and develop new YWCA programs and report aggregate (and not personally identifiable) data about the services provided.

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Question - Required - What is your race/ethnicity?
Please make at least 1 selection from the choices below.

   


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Question - Required - Do you have any special needs?

 


 


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  SECTION III. VETERAN STATUS

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  SECTION IV. SPECIAL CONCERNS

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(Maximum response 255 chars, approx. 5 rows of text)

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  SECTION V. FAMILY/HOUSEHOLD INFORMATION

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  Household Size: Household includes you, your spouse or domestic partner, your biological, step or adoptive children or grandchildren who live with you, other adults living with you who either provide you or depend on you for living expenses, such as food, housing, transportation and clothing.

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Question - Required - Do you or your family members currently receive any public benefits?
Please make at least 1 selection from the choices below.

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  Domestic or Intimate Partner Violence. We are committed to ending intimate partner violence. Because of this, we ask all clients if they have experienced intimate partner violence. Intimate partner violence includes physical assault, sexual assault, stalking, and emotional or psychological abuse. It also includes financial abuse, such as taking your paycheck and/or denying you access to your earnings and financial assets.

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  SECTION VI. EDUCATION, EMPLOYMENT AND INCOME

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Question - Required - What are your sources of income?
Please make at least 1 selection from the choices below.

   


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  If you are employed:

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  SECTION VI. CAREER & WORKFORCE DEVELOPMENT SERVICES

The YWCA’s Career & Workforce Development Services team offers a range of career pathway, training and job placement services. Our ongoing funding is dependent upon our ability to track your employment success over the course of a year. If you access our Career & Workforce Development Services, we will ask you sign a form allowing us to confirm your continued employment and job performance directly with your employer. If you change positions within the year, this authorization will apply to the new position as well.

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Question - Required - What Career Services programs are you interested in accessing?
Please make at least 1 selection from the choices below.

   


  SECTION VII. FINANCIAL WELLBEING

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  SECTION VIII. TECHNOLOGY SKILLS & ACCESS

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Question - Required - I currently have:
Please make at least 1 selection from the choices below.

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Question - Required - I currently have experience with the following programs:
Please make at least 1 selection from the choices below.

   


  SECTION IX. BUSINESS AND ENTREPRENEURSHIP

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  SECTION X. HOW DID YOU HEAR ABOUT US?

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Question - Required - How did you hear about the YWCA? (check all that apply)
Please make at least 1 selection from the choices below.

   


  By clicking the submit button below, I certify that the information in this application is true and correct. I understand that falsification of any information in the application can lead to my disqualification or termination from the Economic Empowerment Institute. I also understand and certify that if I find employment from the time I begin services with the YWCA Economic Empowerment Institute, the Economic Empowerment Institute can verify such employment.
 
I acknowledge that the YWCA Metropolitan Chicago’s Economic Empowerment Institute, which the Catalytic Ventures Career Fellowship falls under, has provided career and workforce development coaching and training to me. This coaching and training has contributed to my ability to secure and maintain employment.
 
I understand that the YWCA is required to track my continued employment for one year from the date of employment and will provide ongoing coaching as needed to help me maintain and/or advance in my new position. In consideration of this, I hereby authorize my current employer to share information related to my current employment status and performance with YWCA staff, upon request. This authorization is valid for one calendar year from the date below.
 
In consideration, and as a condition, of my acceptance by the YWCA Metropolitan Chicago as a participant in its services and programs, I hereby waive, release and hold harmless the YWCA Metropolitan Chicago, its officers, directors, employees, representatives, and volunteers from any and all claims and actions related to or arising out of my participation in services and programs provided by the YWCA Metropolitan Chicago.
   Please leave this field empty