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Youth Employment Programs
Interest Form

First and Last Name:


Phone:

Can you receive texts? Yes No

Mailing Address (with city, state, and zip):


Physical Address (with city, state, and zip):


Email:


Age:
(must be between 16 and 24 years of age)

Do you have a High School Diploma/GED? Yes No

Are you currently enrolled in High School? Yes No
School:
Grade:
Are you in a Career Pathway? Yes No
Pathway/Industry?

Are you enrolled in College or Adult School? Yes No
School:
What Certificate or Degree are you pursuing?


What is your career goal?


Are you on probation? Yes No

Do you have a disability? Yes No

Comments:









Tulare County Office of Education
Services for Education and Employment (SEE)
626 North Akers Street, Visalia, CA 93291

Youth Services & Welfare-to-Work (WTW) Programs
(559) 733-6730 • fax: (559) 737-4074


Tim A. Hire, County Superintendent of Schools
Tulare County Office of Education
All mail to: P.O. Box 5091, Visalia, CA 93278-5091
Physical address: 6200 S. Mooney Blvd., Visalia, CA 93277
phone: (559) 733-6300 • fax: (559) 627-5219

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