Central Intake Form

First Name *

Last Name *

Your Email *

City/Town *

Phone Number *

Date of birth (MM/DD/YYYY) *

(We offer support to 18–26-year old’s)

Do you identify as one of the following indigenous groups?

What supports are you looking to receive from YOUCAN?

Other [what_supports_are_you_looking_to_receive_from_youcan]

Please enter them here

Other [barriers_to_employment_select_all_that_apply]

Please explain here

What type of specific work or schooling would you like support with when you are completed the program?

School Program

If you choose "school program" to the previous question please add it here.

How are you currently supporting yourself? *

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

Do you have a driver’s licence?

No

Learners

Class 5 GDL

Class 5

Do you have access to reliable transportation to get to and from work?

Bus, train, own a vehicle etc.

Yes

No

Are you legally entitled to work within Canada?

Yes

No

Are you interested in a specific program?

How did you hear about YOUCAN?

Select all that apply

Other [how_did_you_hear_about_youcan]

Please explain here

Do you have any more questions or comments?

500 Characters or less. No website links.

Attach your resume

Contact Us