YESS-ILP Participant Registration Form
Foundation for California Community Colleges
Participant Information
First Name ________________________ Last Name _________________________
County of Origin___________________ County of Residence__________________
Age: _____________________________ Race/Ethnicity_______________________
Care Category
Check
One
Foster Care
Kinship Care
Group Home
Transitional Housing
Probation
SILP
Homeless
Education: 8
th
____ 9
th
_____ 10
th
_____ 11
th
_______ 12
th
______ College ________
Other (please explain): _____________________________________
Release Statement
This statistical information will be used to keep accurate records of the services provided by the
community college YESS-ILP program. This information will assist the college in keeping accurate
records of the classes that you take. It will also help the college to keep you informed of upcoming
classes and events within the ILP at your local community college. Your name, address, and phone
number will remain confidential. Statistical numbers (demographics - i.e., gender and education - not
names) may be reported to funding agencies. No unauthorized person will have access to your
information.
Signature__________________________ Date________________________
Age Classification
Check
One
Youth (16-18)
Emancipated Youth (19-21)
Non-Minor Dependent
Adult
Gender
Male
Female
Other
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