PY25 NEXT Success Application

Get started with NEXT Success!

Complete this form to begin your journey with NEXT Success. Following submission, a NEXT Career Coach will reach out to schedule a meeting with you to review your goals and share how our services work.
Applications should be completed by young adults, ages 16-24 (customers) in Clark, Cowlitz and Wahkiakum Counties who are seeking services and support from NEXT Success.

The information provided will be kept secure, private and is only shared with authorized workforce system partners for the purpose of program eligibility and service delivery.
Contact Information
Name:*

First NameLast Name
Preferred Name:
Preferred Pronouns
Pronouns: Self Describe
What county do you currently live in?*

Clark CountyCowlitz CountyWahkiakum County
What area do you live in?*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Preferred method of contact (select all you prefer)*

EmailPhone callText
By selecting text message as preferred contact method, you agree to recieve text messages to the phone number provided from a NEXT Success staff member. Staff will also communicate via email to send important information.
Do you require interpretation/translation for communication in English?*

YesNo
Primary Language
A career coach will contract you via email and/or text message to schedule a time with a phone interpretor.
How did you learn about NEXT Success?*

ParentSchoolFriend or relative (other than parent)Case Manager / other support personCommunity OrganizationCommunity EventFlyer/AdvertisementSocial MediaInternet Search / WebsiteWorkSourceOther
Which community organization / school referred you?*
List who referred you to NEXT Success
Have you participated in NEXT Success programs or services in the past?*

YesNoI'm not sure
If yes, please describe your experience with NEXT Success. What programs or services did you participate in, and what support did you receive?
Demographic Information

Information is kept confidential and helps us to know who we are serving and how we might be able to help.
Date of Birth*

MonthDayYear
Race*

WhiteBlack/African AmericanAsianAmerican Indian/Alaska NativeNative Hawaiian/Other Pacific IslanderMore than One RacePrefer Not to DiscloseTell Us More
Ethnicity*

Hispanic or LatinoNot Hispanic or LatinoPrefer not to discloseTell Us More
Gender*
Gender: Self Describe
Are you currently enrolled in school? *
Name of school*
Current Grade / Education Level*
Are you currently employed?*
Other - please describe:
Name of employer:*
Do any of these apply to you? It's ok if they do! We want to help you get what you need.*

16-24 years oldEligible to work in the United States and can verify my eligibilityNot attending schoolNo high school diploma or GEDPregnant or parentingWorking on getting a GEDHomeless or runawayLow-IncomeReceiving SNAP food benefits (you or your family)Receiving TANF, SSDI, SSI, or other forms of public assistanceJustice involved backgroundCurrently in or aged out of the foster care systemHave a disability (does not have to be diagnosed)
How can we help?

How can we help you in your journey towards employment or schooling?
What are you needing assistance with? Select all that apply*

Getting my GED / High School DiplomaSupport with entrance into post-secondary educationEmployment and job search supportOccupational Training or CertificationShort term work experience/internshipOther
Please describe your career and/or education goals*
Please describe any specific careers, or career pathways that interest you *
What career clusters interest you the most? Select all that apply*

Agriculture and Natural ResourcesArchitecture & ConstructionArts, Audio Video Technology & DesignBusiness Management & AdministrationChild & Youth ProgramsEducation & TrainingFinanceFood & Beverage ServiceGovernment and Public AdministrationHealth ScienceHospitality, Retail and TourismInformation/Computer TechnologyLaw, Public Safety, Corrections, SecurityManufacturingSocial and Human ServicesMarketing and CommunicationsTransportation, Distribution, LogisticsOther
Thank You!
After Submitting an Application

It will be reviewed by the NEXT Success team and a Career Coach will contact you to schedule an appointment within 5 business days.

At that appointment, we'll overview our services, review your eligibility, explore your goals and determine next steps.
This form was completed by:*

Me (customer listed above)Parent/GuardianCase Worker or other supportive adultOther
Please provide your name, relationship to the customer, and your contact information.*
Today's Date*

MonthDayYear
Date
Will you require a translator?
NEXT Success is an equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities.
Should be Empty:

Get started with NEXT Success!

Contact Information

Demographic Information

How can we help?

Thank You!