ArtRecruits Referral Form

Name *

First Name

Last Name

Where are you located? *

Edmonton

Calgary

Phone

(###)

###

####

Date of Birth

MM

DD

YYYY

Guardian Phone (if applicable)

(###)

###

####

Do you have an employment or education goal? *

Yes

No

Do you have an identifiable and self disclosed mental health barrier? *

Yes

No

Are you 18 years of age or older *

Yes

No

Are you currently unemployed *

Yes

No

Are you legally entitled to work or train in Canada *

Yes

No

Are you a Canadian citizen, permanent resident, or person whose refugee status has been conferred *

Yes

No

Have sufficient physical and mental health to participate in the employment process *

Yes

No

Have an identifiable and involved support network *

Yes

No

Available to commit to approx. 12 hours of program work. (zoom, in person or at home) *

Yes

No

Are you currently accepting EI? *

Yes

No

Are you wanting to work 12+hrs/week or connect to further education within the 6-month program? (Requirement) *

Yes

No