Transcription of APPLICATIO N MUST BE SUBMITTE - nyc.gov
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APPLICATIO N MUST BE SUBMITTE - nyc.gov
2022 NYC Ladders for Leaders Participant Application 1. Social Security Number (Please be accurate)2. Last Name3. First Name4. MI5. Birth Date (MM/DD/YYYY) at BirthFemaleMale7. Citizenship CitizenPermanent Resident Other 8. Selective Service Registration # & Date- Males 18 years of age mustbe registered with the Selective Service System to participate in theprogram (if you have not already registered; visit )Date (MM/DD/YYYY)9. How did you hear about us?10. Street Address11. Apartment12. Zip Code13. Do you live in a NYCHA Housing Development?No (If No; Go to question 14)Yes If Yes, Name the Development:14. Borough15. Applicant's Ethnicity (Select one)16. Applicant's Race (Select one)17. Other than English, what Language are you most comfortablespeaking?
applicable certifying disability from a physician, ACS, HRA, School, Social Service agency or authorized entity. Please note: all references to the word current mean documents dated within the last six (6) months or where applicable, documents which are still valid and have not expired.
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