APPLICATIO N MUST BE SUBMITTE - nyc.gov

1 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?

2 S Home Phone #19. Applicant s Cell Phone #21 Name of Parent or Legal Guardian (Last Name)22. First Name23. Emergency Contact Phone #25. Currenteducational status24. Educational-Student TypeWhat school did/do you attend?Indicate last grade completed27. Total family income(gross) for the last SIXmonths28 (A). Number of familymembers currently livingin applicant's household28 (B). Applicant'sHousehold Type29. Is applicant orapplicant s family currentlyreceiving public assistance?YesNo (Skip to #31)30. Type of Public Assistance (Check all that apply)Family AssistanceSafety Nutrition Assistance Program (SNAP)Other31. Is the applicant any of the following (Check all that apply)DisabledOffender/Justice InvolvedFoster CareACS Preventative ServicesDoes Not Apply Homeless/RunawayParent32.

3 School Major32. Grade PointAverage34. Where is your school located?(Check One)In NYC Outside of NYC35. Start and end datesof your summer break?36. Prior workexperience?YesNo37. What is the applicant slong-term career goal? Listthree (3) options:38. Do you have a bankaccount?YesNo39. Interested in opening abank account? in directdeposit? you covered by Medicaid, ChildHealth Plus,Family Health Plus orprivate medical insurance?Yes No .Would you like to receiveinformation about insuranceprogram?NoYesCertification of Accuracy: I, the undersigned, certify that all information on this form is true and correct. I understand that my statements are subject to verification. I further understand that any false statements may subject me to criminal prosecution under both New York State Penal Laws, section and Federal Law, 18 1001, and to civil action for return of all monies received.

4 I agree and accept that I will abide by all applicable rules and regulations of this Information Educational StatusIncome & Other Information Educational and Career Detail Banking Information Applicant SignatureDate: Parent/GuardianSignatureDate: s Email26. Please indicate theschool system you attend:Served in the MilitaryFromTo(MM/DD/YYYY)(MM/DD/YYYY)Ci ty State(MM/DD/YYYY)(MM/DD/YYYY)Please select "Yes" if you would like to receive text updatesYesNo Ladders For Leaders2022 Participant Application OSIS # (DOE Students ONLY)Do you have access to anelectronic device withinternet accessibility?Are you familiar withany of these skills?(check all that apply)YesNoPlease select your preferred Gender IdentityPart 2 - ESSAY QUESTIONS*Q1: What life event has had the most influence on you and why?

5 (250 words or more)RESUME (Attach a hard copy) Each field represents a different section of your resume. Please enter the information accordingly.*CONTACT INFORMATION (Name, Address, Phone/Cell number, EmailEDUCATIONEMPLOYMENT HISTORY / WORK EXPERIENCEVOLUNTEER / LEADER EXPERIENCEHONORS & AWARDSEXTRACURRICULAR ACTIVITIESSKILLSTRANSCRIPT (Attach a hard copy)* APPLICATIO N MUST BE SUBMITTE D BY 11:59PM February 25th, o r m o r e i n f o r m a t i o n a b o u t N YC L a d d e r s f o r L e a d e r s , p l e a s e v i s i tu s a t w w w . n y c . g o v / L a d d e r s o r c a l l D Y C D a t ( 8 0 0 ) 2 4 6 - 4 6 4 6 .For questions #2 + 3, you must select and answer one out of the two:Q2: What are you hoping to gain from the Ladders for Leaders program that will help you achieve your future career goals?)

6 (250 words or more)Q3: What career field are you interested in and why? If you are undecided, what interests would you like to pursue further and why? (250 words or more)2022 Participant Application 2022 Ladders for Leaders Provider List A p p l i c a n t s c a n a p p l y t o a n y o f t h e a b o v e p r o v i d e r s r e g a r d l e s s o ft h e i r b o r o u g h o f r e s i d e n c e .Provider NameAddress Worksite Examples ContactInformation CommonPoint Queens(Formerly known as Central Queens Y)67-09 108th Street,Forest Hills, NY 11375718-268-5011ext. Bank of America, Ernst & Young, MorganStanley, Blackrock, Blackstone, MorganStanley, Macy's, NASDAQ , Hughes Hubbard& Reed, Goldfarb & Fleece, LLP, Kassatex ,Kickstarter, Laura DevineAttorneys, Lawline, LincolnCenter, Medidata, Morgan Stanley, Museumof the Moving Image, National Grid, Neuberger Berman, and Rudin, etc.

7 PENCIL, West 26th Street,5th Floor,New York, NY 10010 Amalgamated Bank, Deloitte,Xandr, Bloomberg , KPMG, LinkedIn , PaulHastings LLP, Boston Consulting Group,Beazley Group, Blueberry Builders,LLC, Uncubed, OEM, Department of Designand Construction, WeWork, Uptown Stories Inc., ,Tishman Speyer, JackResnick+Sons, Sotheby's, and DesignIncubator Inc., etc. Ladders For Leaders2021 Participant Application 1. Proof of IdentityOfficial Picture ID(school, city, state, government issued)IDNYC Municipal ID will be accepted2. Proof of AgeBirth Certificate ORBenefit Card ORNYS Driver/Non-Driver s License ORAlien Registration Card ORValid Passport3. Proof of Social Security NumberSocial Security Card (ONLY)4. Proof of Address (Dated within the last 6 months)Home Utility Bill ORCurrent Lease, Mortgage, Deed ORCurrent Cable Bill (Must have Phone ServiceListed) OROfficial Mail from a Federal, State or City Agency9.

8 Proof of Family Income(Dated within the last 6 months)If Supported by Public AssistanceCurrent EBT Card (with parent/guardian name)AND a recent store receipt ORCurrent Benefit Budget/SNAP Letter OROfficial letter from Social Services (Must includeapplicant s name, Benefit # and date) ORIf Not Supported by Public AssistanceTwo (2) consecutive pay stubs dated within the last six months (Must include payee name, and gross income) OR2021 W-2 form and one (1) pay stub dated within the last six months ORCurrent Pension Award letter ORCurrent SSA Award letter ORUnemployment Benefit Document dated within the last six months ORIf self-employed, 2021 Tax Return including Schedule C or E (if receiving rental income)5. Ladders ApplicationA signed Ladders application is required for all youth.

9 Youth under the age of 18 are required to have the signature of a parent or Proof of Employment AuthorizationReport Card (dated within the last 6 mos ) OROfficial School Transcript ORNYS Driver/Non-Driver s License ORVoter s Registration Card Military Card /Draft Record OR10 Working Papers (Must be age applicable)Working papers can be acquired through yourschool. If you are not attending school, call 311 orcontact your local District for Youth under 18 years of age ONLY16 and 17 years of age: Green Card11. Please provide ONLY if applicableSelective Service Registration Card ORSelective Service Online Receipt Required for males 18 years of age or older8. Proof of Citizenship/Alien StatusValid Passport Birth Certificate ORAlien Registration Card ORI-94 , I-551, I-797 ORCertificate of Naturalization OREmployment Registration CardProof of Disability: Official documentation asapplicable certifying disability from a physician,ACS, HRA, School, Social Service agency orauthorized 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.

10 The status of your application can be found at you are selected for a Ladders opportunity, you will need to submit certain documents online via a secured document submission site. You must submit COPIES of one (1) item from categories 1-9 listed below as it applies to you. These items are needed to officially complete your enrollment so that you are eligible for Ladders for Leaders. Note that some documents may satisfy more than one category ( Birth Certificate or current Passport for categories 2 and 7).Reminder: ONLY COPIES OF THESE DOCUMENTS WILL BE ACCEPTED7. Proof of Educational StatusOfficial High School Transcript OROfficial College Transcript ORUnofficial College Transcript w/ copy of CollegeIDRequired Document Checklist LaddersLadders For Leaders