Jump Start Fellowship Program Mental Health Recovery Specialist APPLICATION Personal Information Name Last First Middle Initial Address: Number and Street City/Town State Zip Code Phone: Home Cell Email Jump Start prepares Fellows for entry-level work in the mental health field. On average entry-level mental health workers make Yes No between $11 - $20 an hour. Are you still interested in Jump Start? Have you ever applied to the Jump Start Fellowship Program Yes No before? If yes, what session? How did you hear about Jump Start? Can you provide proof of your identity and legal right to work in Yes No the United States? If you are undocumented, please provide an explanation of your current status. Do you need any special assistance in meeting the basic Yes No requirements of the program? If yes, please explain
Jump Start Fellowship Program Mental Health Recovery Specialist APPLICATION Personal Information Last First Middle Initial Address: Number and Street City/Town State Zip Code Phone: Home Cell Email Jump Start prepares Fellows for entry-level work in the mental health field. On average entry-level mental health workers make between $11 - $20 an hour. Are you still interested in Jump Start? Yes No Have you ever applied to the Jump Start Fellowship Program before? Yes No If yes, what session? How did you hear about Jump Start? Can you provide proof of your identity and legal right to work in the United States? Yes No If you are undocumented, please provide an explanation of your current status. Do you need any special assistance in meeting the basic requirements of the program? Yes No If yes, please explain Name