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About CYC
Mentoring
Saturday Hoops
UC Med Mentors
College and Career Success
Jobs for Cincinnati Graduates
Good Jobs Challenge Advanced Manufacturing Program
Outcomes
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Success Stories
Get Involved
Volunteer Opportunities
Employment Opportunities
Outstanding Student Nomination
Volunteer Signup Form
Student Signup Form
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Board
YP Board
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Trivia Night
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News
Contact Us
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What We Do
Mission, Vision, & History
About CYC
Mentoring
Saturday Hoops
UC Med Mentors
College and Career Success
Jobs for Cincinnati Graduates
Good Jobs Challenge Advanced Manufacturing Program
Outcomes
Annual Report Card
Success Stories
Get Involved
Volunteer Opportunities
Employment Opportunities
Outstanding Student Nomination
Volunteer Signup Form
Student Signup Form
Who We Are
Staff
Board
YP Board
News & Events
Trivia Night
Golf Outing
Dream Makers
News
Contact Us
Alumni
Menu
What We Do
Mission, Vision, & History
About CYC
Mentoring
Saturday Hoops
UC Med Mentors
College and Career Success
Jobs for Cincinnati Graduates
Good Jobs Challenge Advanced Manufacturing Program
Outcomes
Annual Report Card
Success Stories
Get Involved
Volunteer Opportunities
Employment Opportunities
Outstanding Student Nomination
Volunteer Signup Form
Student Signup Form
Who We Are
Staff
Board
YP Board
News & Events
Trivia Night
Golf Outing
Dream Makers
News
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Participant Profile - Withrow University HS
First Name
Middle Name/Initial
Last Name
Nickname
Current Photo
Street Address
Apt/Suit/Other
City
State
Please select…
Ohio
Kentucky
Indiana
Zip
Email Address
Home Phone
Mobile Phone
Work Phone
Ext.
Birthdate
Gender
Please select…
Female
Male
Other
Race
Please select…
American Indian
Asian
Black, African-American
Hispanic
White, Caucasian
Multi-Racial
Other
No Response
Please provide information for someone who should always be able to contact you, in case we lose contact with you.
Relationship
Please Select..
Mother
Step-Mother
Father
Step-Father
Sister
Brother
Aunt
Uncle
Grandmother
Grandfather
Cousin
Friend
Spouse
Other
First Name
Last Name
Street Address
Apt/Suite/Other
City
State
Please select…
Ohio
Kentucky
Indiana
Zip
Home Phone
Mobile Phone
Work Phone
Ext.
Email Address
Let us know where you are currently enrolled and what plans you have for the future.
Date
School
Please Select...
Aiken New Tech
North College Hill
Oyler
R. A. Taft Information Technology
Western Hills University
Winton Woods
Withrow University
Woodward Career Technical
Other
Grade in School
Please select…
6th
7th
8th
9th
10th
11th
12th
Dropout
In-school Unclassified
College Freshman
College Sophomore
College Junior
College Senior
Masters Degree Program
Doctoral Degree Program
School ID
Other ID
Class Standing
Please Select...
Top 25%
Middle 50%
Bottom 25%
Cumulative GPA
Credits Toward High School Graduation
Credits Required for High School Graduation
Absences Last School Year
Future School and Work Plans
Graduate from high school (diploma)
Obtain a GED.
Dropout of school.
Work full-time.
Work part-time.
Work and attend a two-year or four-year college or other training.
Attend a four-year college.
Attend a two-year college.
Attend a vocational/technical training program.
Enlist in a branch of the military service.
No specific school or work plans at this time.
Other.
If you selected
Attend a four-year college
or
Attend a two-year college
please tell us your major:
If Other:
Are you currently employed?
Employment
Please Select...
Currently Employed
Not Currently Employed
Most Recent Employer
Employer
Job Title
Hours Per Week
Hourly Wage
Employment Date
Are you currently enrolled, or plan to be enrolled, in any training programs?
Occupational Training
Please Select...
Currently Enrolled or Planning to Enroll
Neither Currently nor Planning to Enroll
School or Organization
Program
Current Living Situation
Please Select...
Live with both parents or step parents
Live with Mother
Live with Father
Live with relative
Live with friends
Live alone
Live with husband or wife
Live with foster parents or in a group home
Homeless
No Response
Number in Family/Household (including yourself)
Mother/First Parent's Education
Please Select...
Less than a high school diploma
High school diploma or equivalent (no college)
Some college or postsecondary education
Completed college
Do not live with Mother/First Parent
Father/Second Parent's Education
Please Select...
Less than a high school diploma
High school diploma or equivalent (no college)
Some college or postsecondary education
Completed college
Do not live with Mother/First Parent
If you live with your Mother/First Parent, is he/she currently employed?
Please Select...
Yes
No
Do not live with Mother/First Parent
If you live with your Father/Second Parent, is he/she currently employed?
Please Select...
Yes
No
Do not live with Father/Second Parent
Free/Subsidized Lunches
Please Select...
Eligible for Free Lunches
Eligible for Subsidized Lunches
Not Eligible
Government Assistance (check all that apply)
Welfare (TANF)
Public Assistance
Supplemental Security Income
Other cash income from the government not including retirement benefits
No government assistance
Barriers
A1 - One or more modal grades behind peers
Number of Grades
A2 - Has repeated a grade in school
A3 - Low academic performance
A4 - Basic skills deficient (reading and math in particular)
A5 - Limited English proficiency
A6 - Did not pass the state proficiency exam
Reading
Writing
Math
Science
Other
A7 - A past record of excessive absences as verified by school officials
A8 - Has been suspended, expelled, or put on probation during high school
A9 - Has dropped out of school previously
High School Attended
Last Grade Level Completed
A10 - Participant household does not have internet connectivity in order to complete virtual learning assignments or participate in JAG training.
A11 - Participant household does not have the technological equipment in order to complete virtual learning assignments or participate in JAG training.
E1 - Family environment not conducive to education or career goals
E2 - Mother did not graduate from high school
E3 - Father did not graduate from high school
E4 - Mother does not work
E5 - Father does not work
E6 - Is pregnant
E7 - Has dependent child(ren) in the home
E8 - Is parenting
E9 - Has documented alcohol and/or substance abuse
E10 - Convicted of a criminal offense other than a traffic violation
Offense
E11 - Has a record of violent behavior
E12 - Homeless
Number of Residences in Past Year
E13 - Runaway
E14 - Requires child care during work or school
E15 - Needs transportation to and from work or school
E16 - Foster Care
Number of Placements in Past Year
E17 - Child of Incarcerated Parent
E18 - Child of Migrant Worker
E19 - Parent(s) currently or formerly in the military (Use to ID a military engaged student)
L1 - Currently in foster care (LEAP Only)
L2 - Previously in foster care. (LEAP Only)
L3 - Currently involved in the juvenile justice system. (LEAP Only)
L4 - Previously involved in the juvenile justice system. (LEAP Only)
L5 - Currently involved in the adult justice system. (LEAP Only)
L6 - Previously involved in the adult justice system. (LEAP Only)
L7 - Convicted of a juvenile criminal offense. (LEAP Only)
L8 - Convicted of an adult criminal offense. (LEAP Only)
L9 - Born outside of the U.S./Is an immigrant. (LEAP Only)
L10 - Is a refugee. (LEAP Only)
O1 - Other
Explain
P1 - Special education certified
P2 - Lacks motivation or maturity to pursue education or career goals
P3 - Emotional disorder which impairs education or career goals
P4 - Has a disability
Disability
P5 - Health problems which impair education or career goals
W1 - Economically disadvantaged as defined by public assistance, TANF, or free lunch
W2 - Having inadequate or no work experience
W3 - Lacks marketable occupational skills that are in demand in the local labor market
W4 - Has been temporarily or permanently laid off or have had hours reduced due to the 2020 Corona Virus Pandemic.
W5 - Has a Parent/Guardian/Supporting Adult who has been temporarily or permanently laid off or have had hours reduced due to the 2020 Corona Virus Pandemic.
Send