Apply | Programs | Heart of Oregon Corps

Which Heart of Oregon Corps Program(s) are you applying to? *REQUIRED

AmeriCorps
COYCC
Stewardship
YouthBuild
Not Sure (a staff member will call to discuss which program fits your needs)

First Name *REQUIRED

Last Name *REQUIRED

Mailing Address (Street) *REQUIRED

Mailing Address (Street) 2

City *REQUIRED

State *REQUIRED

Zip Code *REQUIRED

Phone Number (Cell) *REQUIRED

Phone Number (Home)

Email Address

Secondary Contact Name

Phone numbers and addresses can change quickly. Please provide us a secondary or emergency contact so we can reach you.

Secondary Contact Relationship to You

Secondary Contact Phone Number

Date of Birth *REQUIRED

Current Age *REQUIRED

Gender (optional)

Male
Female
Other

Race/Ethnicity (optional)

Asian/Pacific Islander
Black
Hispanic
Multiracial
Native American
Other
White

Are you a US Citizen, National or Permanent Resident Alien? *REQUIRED

Yes
No

How did you hear about Heart of Oregon Corps?

Have you ever been in a Heart of Oregon Corps Program before? *REQUIRED

Yes
No

If you answered YES, please name the Program, Year, and reason for leaving.

What is your high school education status? *REQUIRED

Currently attending high school
Dropped out of high school
Graduated high school or earned GED
Attending college
Some college

What school/program are you attending?

If currently attending high school or GED program:

What year did you earn your Diploma/GED?

If graduated from high school or GED program:

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Which certification did you earn?

Regular High School Diploma
Modified High School Diploma
GED

Most Recent Employer

Dates of Employment

-

Skills Learned

Reason for Leaving

Check the areas that are of interest to you while in program *REQUIRED

Gain Construction Skills
Gain Land Conservation Skills
Explore Career Options
Earn High School Credits
Complete GED
Complete Diploma
Prepare for College
Attend College

What are your goals after program completion? *REQUIRED

Return to High School for Diploma
Attend College/Vocational School
Find Full-Time Employment
Find Part-Time Employment
Not Sure

Tell us why you want to join a Heart of Oregon Corps program, and what you hope to learn or gain through your service

Applicant Signature (type full name) *REQUIRED

Today's Date *REQUIRED

Online applicants under 18 will be required to obtain a parent/guardian signature during the application process

Parent/Guardian Signature (Type full name; if applicant is under 18)

Apply for a Program

Heart of Oregon Corps: Initial Application for ALL Programs

Contact Information

Secondary Contact Information

Demographic Information

Education History

Work History

Personal Goals

Motivational Statement

Certification