Thank you for completing the Advancing Communities Together enrollment form. Follow the instructions for each of the sections in the form to ensure accuracy and thoroughness.
The demographic/miscellaneous information that Advancing Communities Together (ACT) collects is important for program placement and funding. This information is important for all applicants entering our program.
Note: Barriers to program attendance could make it difficult to attend the program every day.
Examples of this could be: Lack of reliable transportation, a need for child care, etc. Please Note: Depending upon the barrier, ACT may be able to provide or refer you to the support you need.
If you have a job or if you collect government funds (Cal-WORKS, SSI, SDI, etc, do NOT fill out this form
I, do hereby certify that I do NOT receive income from ANY of the following sources below.
I understand sources of income include, but are not limited to the following:
I certify that the foregoing information is true, complete and correct. Inquiries may be made to verify
l also understand that false statements or omissions are grounds for disqualification from Antelope
I, authorize the exchange of educational, medical, psychosocial and/or social service information
between the AV YouthBuild and the individual(s) or agency(ies) listed below.
This authorization will be valid for 24 months from the date of signature or until revoked in writing
prior to that date.
I have the right to be informed about what information will be released.
I have the right to limit or specify; the information that will be released.
I understand that AV YouthBuild needs this information in order to assist me in completing my goals and receiving the services I need.
I understand that confidentiality cannot be maintained in the event of suspected child abuse or the
threat of-destructive behavior towards me or others and that, in such an instance, AV YouthBuild
staff working with me is mandated by law to report this.
Please complete the information below in the following format:
Please List (individual or agency): Antelope Valley YouthBuild
Contact Person: Tupea Baer, Registrar
Phone Number: 661.266.8900
Email Address: Tbaer@youthbuildcharter.org
Contact Person or Agency 1:
Contact Person or Agency 2:
Contact Person or Agency 3:
All trainees are required to attend Education and/or Vocational Instruction Monday through Friday. Friday
Leadership classes are an integral part of AV YouthBuild and a graduation requirement. In the event of illness, doctor appointment, emergency, court appearance, and any and all other absences, the following
procedure must be followed in order for an "excused absence" status to be granted:
1. The trainee must make a personal phone call to the desk of the AV YouthBuild. Registrar/Attendance Monitor 661-266-8900. All calls must be made prior to 8:30 am the day the absence will occur. An explanation must be given to the person who answers the phone, including how long the trainee will be out and the reason for the absence. In the event that no one- answers, full details must be left on the voicemail. Please leave a voice mail message if no staff is available: clearly state your name, the reason for your absence and a phone number where you can be reached.
2. The staff member who takes a message concerning an absence will log that message into the telephone call log or database, being sure to include the date, time of the message and an accurate of the conversation.
3. All calls should be made to the front desk of the AV YouthBuild Registrar/ Attendance Monitor in addition to your assigned advisor.
4. Documentation must be presented when the trainee returns to AV Youthbuild. In the event of an illness, a note from a family member will be acceptable. If documentation is not presented to the Registrar/ Attendance Monitor on the day of return to the program, the absence will be counted as unexcused.
5. A trainee is subject to being self-selected out from AV YouthBuild if the trainee has three or - more unexcused consecutive absences and/or trainee attendance is low. Please communicate any attendance issues with a staff member, AV YouthBuild is willing to work with you.
I have read the attendance policy and agree to comply with it.
Appearance is often thought of as one of the outward signs or indications by which a person or thing is assessed. We at AVYB and its members have established a culture of respect for learning in hopes of empowering all members toward achieving their personal and career goals. In doing so, it is required that all members be in dress code at all times. Failure to respect this dress code will result in not being allowed to participate in the program until they are appropriately dressed.
*We agree that uniforms are a plus.We agree not to wear gang attire.
*We agree with no short clothing. Shorts should be to t*e knees. No cut off shorts.
*We agree to not expose our midriff, chest area or wear tank tops or low cut blouses.
*We agree on no hats of any kind (except YouthBuild hats) on campus (including hoods).
*We agree to wear our pants at our waists.
*We agree to not wear clothing that is excessively baggy.
*We agree that if you are breaking the dress code, you will get verbal constructive reminders before hat is confiscated for the day.
*We agree that if we are out of dress code, we may be sent home immediately or not allowed on
campus after check-in.
*We agree that blue jeans will not have holes or slits exposing skin.
*We agree not to wear open-toe shoes or high heels (unless special event attire is accepted).
I have read the dress code policy and agree to comply with it.
Please be advised that YOU ARE SUBJECT TO RANDOM SEARCHES at the discretion of the AV
YouthBuild Staff. POSSESSION OF CONTRABAND OF ANY SORT WILL BE RESULT IN TERMINATION PER
THE MEMBER'S MANUAL. Failure to comply with a request to search your person may result in a request
in a request to have a law enforcement officer-search you.
The RANDOM SEARCH POLICY is not designed to invade your privacy or accuse you of wrongdoing.
Random searches will be conducted to maintain the integrity of the YouthBuild program and ensure that
all YouthBuild members and staff have a safe and drug-free workplace.
Please review the DRUG-FREE WORKPLACE policy listed below:
Although AV YouthBuild is not a drug rehabilitation program, we have a policy of maintaining Drug-Free
Workplace and Environment'' In order to be an effective leader and to be successful in the workplace, in
institutions of higher learning, and in life, members must be clean and sober. All members are tested for
illegal drugs within the first month of the program. You may elect to waive any test, which is an admission
to drug usage and will be placed on a Level I Contract. You may be randomly drug tested throughout the
I have read the Drug Test and Random Search Policy and agree to comply with it.
I hereby authorize staff for AV YouthBuild to do the following: