Jobs for Nevadas

Graduates
Participant Profile

Date: _____________________________
First Name: __________________________ Last Name: ____________________________
Nickname: ___________________________________

Social Security Number: ____________________________ Student ID#: ____________________________

Address: ______________________________________________________________________
City, State, Zip Code: ____________________________________________________________
County: _____________________________________________________
Home Phone: _________________________ Cellular: _________________________
Work Phone: _________________________ Extension: ___________________
E-mail Address: _________________________________________________________________
Birthdate: _____________________________________ Gender: __________________
Race: Black, African American ____ White, Caucasian ____
Asian ____ Hispanic ____
American Indian ____ Multi-Racial ____
Other (please specify) ____________________________________
Current Grade: _____________________
School and Work Plans: (circle one)
a. Graduate from high school (diploma)
b. Obtain a GED
c. Drop out of school
d. Work full time
e. Work part time
f. Work and attend a two-year or four-year college or other training
g. Attend a four-year college Major: _______________________________________
h. Attend a two-year college Major: _______________________________________
i. Attend a vocational/technical training program
j. Enlist in a branch of the military service
k. No specific school or work plans at this time
l. Other Specify: ______________________________________________

Are you currently employed? YES ____ NO ____

Note: If not currently employed, please enter the previous or last employment
Employer: __________________________________________________________
 Job Title: _____________________________________________
Hours: _______________________ Wage: ____________________
Date: _________________________________________

Are you currently enrolled or planning to enroll in an occupational specific training

separate from JAG? YES ____ NO ____

School: ___________________________________________________________
Program: ___________________________________________________________

What best describes your current living situation? (circle one)

a. Live with both parents or step parents
b. Live with mother
c. Live with father
d. Live with relative
e. Live with friends
f. Live by myself
g. Live with husband or wife
h. Live with foster parents or in a group home

Number of persons in family or household, including yourself: ________________________

Mothers Education: (circle one)

a. Less than high school diploma

b. High school diploma or equivalent (no college)
c. Some college or postsecondary education
d. Completed college
e. Unsure

Fathers Education: (circle one)

a. Less than high school diploma

b. High school diploma or equivalent (no college)
c. Some college or postsecondary education
d. Completed college
e. Unsure

If you live with your mother, is she currently employed? YES ____ NO ____
Do not live with mother ____

If you live with your father, is he currently employed? YES ____ NO ____
Do not live with father ____

Are your parent(s) currently or formerly in the military? YES ____ NO ____
Are you eligible for free or subsidized lunches? YES ____ NO ____
Free lunches ____ Subsidized lunches ____

Cumulative GPA: __________

Number of absences for the previous school year: __________

How many credits do you have towards high school graduation: __________

Check all government assistance:

______ Welfare (TANF)
______ Public Assistance
______ Supplemental Security Income
______ Other cash income from the government not including retirement
benefits
______ No government assistance

Class standing: Top 25% ______

Middle 50% ______
Bottom 25% ______

Were you in a JAG program at another school? ___________

If Yes Identify what school you transferred from: ______________________________

____________________________________ _________________________________________
Participants Signature JAG Specialists Signature

______________________________ _______________________________
Date Date