YSC Programs Application Form

This field is for validation purposes and should be left unchanged.

Please complete this form to indicate your program(s) of interest. If you need assistance completing this form please contact Jennifer Madonia, Director of Training at jennifer@yesshecaninc.org

Applicant's Name(Required)

First Last

Applicant's Preferred Name(Required)

Preferred Pronouns(Required)

Applicant's Date of Birth(Required)

Applicant's Phone(Required)

Applicant's Email(Required)

Applicant's Address(Required)

Street Address Address Line 2 City State ZIP Code

Parent/Guardian/Emergency Contact's Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone (If different from above)(Required)

Address (If different from above)(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Please select the program you are applying for(Required)

Job Training Program. Develop job readiness skills in preparation for employment. Offered Mon. to Thurs. 9:30 am to 2:00 pm

Mentorship Program. Program designed to enhance employability and build network. Dates and times vary upon participants’ availability

Peer Connect. After school program for teens and young adults to build social connections. Offered Tues. and Thurs. 3:30 pm – 5:00 pm

Your Social Community (Available soon)

Interest in Work (Applicable for Job Training and Mentorship Programs ONLY)(Required)

Trainees who are accepted into Yes She Can’s program agree to participate in the process of enrolling in ACCES-VR and OPWDD Supported Employment services, when eligible. It is necessary to the ongoing success of our trainees that they have the necessary support services in place prior to graduating from our program. Please answer the questions below to indicate your plans for future employment.

Yes, with ACCES-VR/my state’s VR office

Yes, with OPWDD

No, I have applied but not been approved

No, and I don’t plan to apply for services

Not sure

If you answered "No" to the previous question, please describe your approach to obtain and maintain employment after completing the Yes She Can program.

Medical History

Please complete this section to the best of your ability.

Do you have any medical conditions that we should know about (example: epilepsy, diabetes, or allergies)? If yes, please describe below.(Required)

Do you require any physical accommodations to participate in the program? If yes, please explain.(Required)

YSC programs are designed for autistic individuals and others with learning differences. Our staff members are trained and prepared to serve many aspects of these disorders. However, we are not a therapeutic or clinical program. Please describe any behavioral or emotional challenges that typically arise.(Required)

Describe situations or conditions that may trigger you to feel distressed or dysregulated. Describe how you deal with these feelings and what helps you to recover.(Required)

Getting to Know You Better

Please provide the following information as accurate as possible.

How did you hear about our programs?(Required)

Why do you want to participate in YSC program?(Required)

Have you had any jobs, internships, or volunteer experiences in the past?(Required)

Do you have any hobbies? What do you enjoy doing in your free time?(Required)

What are your strengths? What do you think you do well?(Required)

If you are seeking employment, what would be your ideal job?(Required)

How will you get to and from the program?(Required)

I will drive myself

Public Transportation

A caregiver will drop me off and pick me up

Paratransit

Authorization and Signature

You hereby authorize Yes She Can Inc. to use any medical information provided for purposes of evaluation of your application to participate in any of our programs and for the purpose of facilitating a successful training experience. Any medical information may be shared with the staff, volunteer job coaches, and anyone who needs to know such information in connection with the purposes of Yes She Can Inc., to the maximum extent permitted by law. You agree that you have voluntarily applied to participate in the Yes She Can program and that any statements and representations you have made are being relied upon by Yes She Can in considering you for selection as a program participant and to facilitate a successful training experience at. You hereby represent that all statements, disclosures and representations made by you in this application to participate and any other document or agreement that you sign in connection with your participation in the Yes She Can program, and that you otherwise provide to Yes She Can, are true, accurate and complete, and you also agree to immediately inform Yes She Can if any of the information you provide becomes inaccurate or incomplete at any time during your participation in any of our programs.

Applicant's Signature

Parent/Caregiver's Signature

Medical History

Getting to Know You Better

Applicant's Sensory Profile

Communication Skills

Authorization and Signature