Summer Youth Employment Program Application

Each applicant is allowed to apply only once for the program.

It is important that you complete all fields in the application. Please note that we may contact you or your parent/guardian by email, text or phone, so if your address, email, or phone number changes after submitting this application, let us know by calling us at (954) 202-3830 or emailing syep@careersourcebroward.com.

If selected, the youth are required to attend an in-person interview with their Parent/Legal Guardian to complete the eligibility process.

Youth's Personal Information


Last Name: (Jr, Sr, III):
Social Security Number: (Example: 123-45-6789)
Date of Birth: (Example: 06/09/2007)
Age you will be on 06/08/2026:
Your birthday must be between 06/09/2007 and 06/08/2010 (inclusive). A valid I.D. will be required.

Gender:

Are you legally able to work in the U.S.?
If you are not a U.S. Citizen, you must provide valid proof of current eligibility to work in the U.S.:
  • Permanent Resident Card
  • Valid Social Security Card
  • Alien Registration Receipt (Form I-551)
  • Employment Authorization (Form I-766, Form I-94 or I-94A)
If you cannot provide any of the above, you will not be able to participate in the program.

Address/Contact Information

This is the address used to determine your eligibility.
Incomplete or inaccurate information will prevent your eligibility documents from reaching you and result in non-participation.

You must be a Broward County Resident to participate in the program!
(NO City or Zip Code in Street Address line, please. No PO Box will be accepted.)

(Example: 1234 Main Street)
(Example: Building 2, Apt 304 - leave blank if not applicable)
City:      
State:    
Zip Code:  
Home Youth Phone Number: (Example: 954-202-3830)
Youth Email Address:
Verify Email Address:
Youth Cell Number:

Parent or Guardian's Contact Information

Parent or Guardian's Name:
Telephone Number: (Example: 954-202-3830)
Cell Phone:
Email Address:
Case Manager/Success Coach First Name:
Case Manager/Success Coach Last Name:
Case Manager/Success Coach Title:
Case Manager/Success Coach Program Name:
Case Manager/Success Coach Phone Number:
Case Manager/Success Coach Cell Number:
Case Manager/Success Coach Email Address:

Demographic Information

School Identification Number (Student ID#):
School Name?
In August 2026, in what grade will you be?
Home Arrangement:
Household Income:
Race:
Ethnicity:
Country of Birth:
Language Spoken at Home:
Cultural Influence:


Work Experience Information

Worksite assignment preference (City):
How do you plan to get to your worksite?
List any languages, other than English, that you speak:
What type of work experience would you prefer (1st Choice)?
What type of work experience would you prefer (2nd Choice)?
This will help us to match you to available jobs closely related to your preference. Please note there is no guarantee you will be placed in the exact preference you selected.

  Select all that apply to you.






Have you been CONVICTED of ANY violation of the law, other than minor traffic offenses, or pleaded NOLO CONTENDERE to criminal charges, even if adjudication was withheld?




NOTE: An arrest or conviction does not automatically disqualify you from participating in the work experience program. Some worksites are not allowed to employ individuals with certain offenses. Your information will make it easier for us to develop appropriate jobs and to be able to place you if you are selected.
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Please:  Click the Submit button only ONCE.
Make sure all your information is correct BEFORE you click Submit.
If the "SUBMIT" button is greyed out, you may have missed answering a question. Ensure all questions are answered.
All information on this form is correct and accurate: ()



Your ELIGIBILITY DOCUMENTS will be mailed if you have been SELECTED for the program.
If your information changes at any time, please call (954) 202-3830 or email to syep@careersourcebroward.com.
Please DO NOT CALL to check if you were selected!!
2025