YouthBuild Application

Last Updated: 02/10/2026

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Step 1 of 4 - Important Application Information

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YouthBuild of South Central Illinois

Program Overview

A program designed to serve individuals between the ages of 16 and 24 who are unemployed and undereducated. Participants will have the opportunity to work toward their GED while learning construction skills. There is also opportunity to obtain a hospitality certification. Strong emphasis is placed on leadership development and community service.

What You Will Gain from YouthBuild

Education – Prepare for GED, vocational school, and/or college
Job Training – Work habits, time management, career pathways, interviews
Leadership Development – Advocacy and community engagement
Counseling – Childcare, transportation, substance abuse support

Education & Training Opportunities

HSE / GED Certificate
NCCER Certificate
NRF Customer Service & Sales Specialist (CSS)
OSHA 10 Hour Certificate
Fork Lift Operator Certificate
First Aid & CPR (including AED)
General Employment Skills
Resume Writing
Interview Practice
Placement Assistance (College, Military, Employment)
Professional Counseling for Substance Abuse Recovery
Continued Support from Professional Staff

Program Time Commitment

Participants are expected to spend 12 hours per week in an academic setting with emphasis on reading, writing, math, construction, and GED preparation.

The remaining 12 hours per week will be spent at work sites where housing rehabilitation and construction activities take place.

Program Location & Contact

YouthBuild
4618 Broadway St.
Mt. Vernon, IL 62864

Phone: 618-242-6723

Name*

First Last

Address*

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

Phone*

Alternate Phone

Date of Birth (DOB)*

Month

Day

Year

Age*

Ethnicity*

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White/Caucasian

Two or More Races

Other

Preferred Language*

English

Spanish

French

German

Other

Your Current Situation (Please check any or all that apply.)

Currently in foster care?

Receiving state insurance/Medicaid?

Receiving any SNAPS or TANF benefits?

An adult or youth offender?

Youth of an incarcerated parent or legal guardian?

Would you be considered first generation post-secondary education (college)?

Are you registered to Vote in Illinois?*

Are you registered in Selective Services Database?*

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Household members living with you at the above address:

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First and Last name, Relationship, Age of household members

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Where did you hear about YouthBuild?

Court System

Probation Office

Truancy Office

High School Counselor

Past Participant

Social Media

Other

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Why are you interested in being in this program?

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What is your dream job?

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If you are accepted into this program, you will be expected to spend 12 hours/ week in an academic setting with emphasis placed on reading, writing, math and construction as well as GED preparation. The remaining 12 hours will be spent at work sites where housing rehab/construction will take place. Programs hours are: Monday through Friday, 8:15 am to 4:00 pm.

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Health

Do you have any physical, medical, or health problems?*

If yes, please describe:

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Do you wear eyeglasses

Yes

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Do you have asthma?

Yes

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Do you have Diabetes?

Yes

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Do you smoke?

Yes

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If you smoke, can you limit your smoking to breaks and lunchtime?

Yes

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Have you ever had a physical examination?

Yes

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If yes, when was your last physical exam date?

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Education

Are you considered a High School drop out?*

Did you have an IEP?*

If yes, what accommodations were made for you?

Have you ever been enrolled in an Adult Education Program or GED/HSE training program?*

If yes, give the name and location of the Program.

Dates you attended this Program?

Did you complete this Program?

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Did you take any shop courses in school?

Yes

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Driving

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Do you own/have access to a car?

Yes

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Do you have a valid Driver's /Operators License?

Yes

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Has your Driver's/Operators License ever been revoked?

Yes

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Training and Work History

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Have you ever been in another training program?

Yes

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If yes, give name and location of program:

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Dates you attended this program:

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Did you complete the program

Yes

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Current Employment

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Have you ever held a job before?

Yes

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Are you currently working?*

If yes, is your job considered Full Time or Part Time?

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If yes, Name and Address of Company:

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If yes to above, Start and End Date:

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If employed, what is your current hourly wage rate per hour?

If employed, what is the number of hours, on average, you work each week?

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If yes to above, Job Title:

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If yes to above, Supervisor's Name and Title:

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If yes you above, Job Description:

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Reason for Leaving?

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Construction/ Hospitality Experience

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Have you had any construction experience?

Yes

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Was it a paid experience?

Yes

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Please describe this experience:

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Have you had any hospitality experience?

Yes

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Was it a paid experience?

Yes

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Please describe this experience:

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Mental Health History

Have you ever been diagnosed with a mental health condition?*

If yes, please give date and diagnosis.

Do you take any medication(s)?*

If yes, what medication(s) do you take and how often?

Have you ever been hospitalized for any medical, emotional or mental health reasons?*

If yes, when and why?

Are you currently receiving mental health services or treatment?*

Is there a family history of mental illness?*

Do you identify with the LGBTQIA+(Lesbian, Gay, Bisexual, Transgender, Questioning, Intersex, Asexual, and A gender +) Community?*

Emergency Contact Information

Contact 1 - Name

First Last

Contact 1 - Relationship

Contact 1 - Phone

Contact 2 - Name

First Last

Contact 2 - Relationship

Contact 2 - Phone

Contact 3 - Name

First Last

Contact 3 - Relationship

Contact 3 - Phone

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Supports

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Name at least two people that have been positive influences or role models in your life

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How have these persons been influential in your life?

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Verification Statement

Verification Date*

MM slash DD slash YYYY

Applicant Name*

Applicant Consent*

I certify that the all information in this application is correct to the best of my knowledge and that there is no intent to commit fraud. I have been advised that this information will be entered into a computerized system and may be shared with other agencies for the purpose of administering programs of these agencies. I have the right to inspect this information and initiate appropriate corrections through the administering agency. I further certify that I have been informed of my rights to file a complaint.

Guardian Name*

Guardian Consent*

As guardian of this applicant, I certify that I have reviewed this information, and I approve of this submission of the applicant's information.