Save Our Sons Application
    EMPLOYMENT AND EDUCATIONAL GOAL
    Health (as appropriate)
    Legal Issues
    ​FAMILY INCOME: 
    PLEASE NOTE:  Income  includes  wages,  salaries,  tips;  self-employment  or  business  income;  unemployment & disability  income;  retirement  &  insurance  income; public assistance;  interest and dividend income; alimony;  child support; gift income; and armed forces income for all family members 18  years of age and older. Each family member over the age of 18 with income will be required to submit a Source of Income Documentation Form (and the related attachments). 

    FAMILY INCOME TABLE (BELOW): 
    Enter in  the number of persons in your family.  Family Size includes children (0-17 years old) and adults (18+years old). 
    Then enter in your family annual Income category.  Family Income must include income for all adults in family. 
    Authorization to Release Information
    CERTIFICATION: (Please read before signing) this organization is supported with Federal funding.
    According to Title 18, Section 1001 of the U.S.Code, it is a felony for any person to knowingly and willingly make false or fraudulent statement to any dep artment of the United States Government. By signing this Document, I certify under penalty of perjury, that all the information on this application is corr ect to the best of my knowledge and belief, and I acknowledge that such information is subject to verification. I also acknowledge that my failure to prov ide necessary documents within areasonable period of time or falsification of this information shall be grounds for my termination from the program. I authorize the release of said information to the City of St. Louis and state and federal agencies    .

    I am currently receiving services through the Urban League Save Our Sons Program. I understand this is a program that helps to improve employability skills & development.   The services include education options, mentoring, leadership development, and career development. Additional services for employability skills include, career exploration which help to increase awareness for long term success. Counseling and guidance services will also be provided for the purposes of completing both your Objective Assessment and Individual Service Strategy.  The following information must be secured on all Save Our Sons participants:
    • Attendance 
    • Verification of Employment
    • Social/Supportive Service needs
    • Date of birth
    • Proof of Residency/Income
    • Other work related documents
    I consent to the releasing of the above information to the Urban League by signing on the line below. I understand this information is required for any person to qualify for participation in this program.  I understand that this document will be valid for the next five (5) years from the date signed

    Client Confidentiality: I understand that the information collected for the Save our Sons program will be used only to assist me and will not be shared with any 3rd parties. I also understand that individuals working at the Urban League and with me will only release information to me.  

    Photo Release and Story Form: I do hereby grant permission to the Urban League of Metropolitan St. Louis, Inc. Save Our Sons (SOS) Program to use images taken during my participation with the Urban League. Such use includes display, distribution, publications, transmission or other use of photographs or images and/or videos taken of me for use in materials that include but may not be limited to printed materials such as brochures and newsletters, video and digital images such as those on the Urban League website.I grant permission to use my images in print, video and digital media.  I agree that these images may be used by Urban League Save Our Sons (SOS) for a variety of purposes and that these images may be used without further notification to me.  I do understand that my last name will not be used in conjunction with any video or digital images.