Project SEARCH Application 2025-26

Applicant Info

This area is intended for the applicant's personal information, not the parent or guardian's personal information.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School / Program currently attending*
Date of Birth*

MonthDayYear
Email Address*
example@example.com
Home Phone
Please enter a valid phone number.
Cell Phone*
Please enter a valid phone number.
Gender*

MaleFemale
Parent/Guardian/Support Staff Info
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Home Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Final placement into program will depend upon the submission of required documentation and CDDO eligibility, as well as participating in and the results of a combination of interviews and assessments. If accepted into the Project SEARCH program, the applicant agrees to seek competitive employment in the Johnson County area with the support of Project SEARCH/JCDS staff at the completion of the Project SEARCH program. Competitive employment is defined as working at least 16 hours a week in a non-seasonal position at a diverse work setting making prevailing wage or higher.

Release: I agree that my records may be transferred to the Project SEARCH program from their school, day program, and case manager for review by the Project SEARCH staff as part of the selection process.
Applicant Signature*

Clear
Date*

MonthDayYear

Skill Inventory and Development Interest
What types of internship experiences are you interested in participating in? (Please select at least three.)*

ReceptionOffice Work/Clerical WorkCustodialDish-Room/Food PrepDining Room AttendantLaundryMaintenanceHospitality/Food ServiceOther

Transportation to Project SEARCH
One of our partners is Workforce Partnership. They have money to help you with transportation, so you can get free rides from a bus. This is so you can come to Project SEARCH even if you don't have a good way to get here. To do this, you will need to sign up with Workforce Partnership. We help you sign up if you are accepted into Project SEARCH.

Ride KC Freedom

We usually use Ride KC Freedom to give you a bus ride. They decide where and when the bus goes. The bus rides are usually less than an hour, but it might be longer than an hour if you live far away. You might need to catch the bus early in the morning or wait a while after Project SEARCH ends. We can't promise another free way to get to Project SEARCH if the bus rides are long or if the times change. Ride KC can also change the bus routes if they need to.

If Ride KC Can't Give You a Ride

Some people might live too far away from the bus, or there might be a lot of people using the bus. If your ride would take more than one and a half hours, Ride KC can't take you. We can sometimes find other rides. We can help you figure out how you can get here, but other ways might cost money.

Driving by Yourself

If you can drive on your own, Workforce Partnership can give you cards to pay for gas. The amount is based on how far you need to go, not on the miles you drive. We can't give money to your parents to drive you.

Other Transportation

You can ask family, friends, or other people to give you a ride instead, but you need to pay them yourself.

By signing below, I acknowledge I have read and understand the above information.
Applicant Signature*

Clear
Date*

MonthDayYear

Employment/Volunteer Experience

List jobs you do or have done in school or in the community. Please attach additional sheets if needed or attach your resume if available.
Experience 1
Employer/Organization
Job Title
Job Duties
Supervisor Name
Dates
Contact Phone Number
Please enter a valid phone number.
Paid or Unpaid?
Experience 2
Employer/Organization
Job Title
Job Duties
Supervisor Name
Dates
Contact Phone Number
Please enter a valid phone number.
Paid or Unpaid?
Experience 3
Employer/Organization
Job Title
Job Duties
Supervisor Name
Dates
Contact Phone Number
Please enter a valid phone number.
Paid or Unpaid?

References
Reference 1
Name*

First NameLast Name
Relation to you*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Reference 2
Name

First NameLast Name
Relation to you
Phone Number
Please enter a valid phone number.
Email
example@example.com
Reference 3
Name

First NameLast Name
Relation to you
Email
example@example.com
Phone Number
Please enter a valid phone number.
Should be Empty:

Project SEARCH Application 2025-26

Intern Participation Agreement

Applicant Info

Parent/Guardian/Support Staff Info

Skill Inventory and Development Interest

Transportation to Project SEARCH

Employment/Volunteer Experience

Experience 1

Experience 2

Experience 3

References

Reference 1

Reference 2

Reference 3