Unlock Your Potential with Memphis Urban League

NextUp Career Readiness Program Participant Registration Form

Thank you for your interest in the Memphis Urban League NextUp Career Readiness Program.
The Memphis Urban League is committed to empowering individuals and strengthening our community through workforce and economic development. NextUp is a 6-week program designed to equip participants with the skills, tools, and support needed to secure employment, advance their careers, and achieve economic stability.

Through interactive workshops, career coaching, and employer connections, participants gain practical strategies for success in today’s workforce.

Please complete this form so we can assess your eligibility, understand your career goals, and connect you to the training, resources, and opportunities that best support your success.

SECTION 1: BASIC INFORMATION

Full Name(First & Last)

Date of Birth

Age

GenderMaleFemaleNon-binaryPrefer not to answer

Phone Number

Email Address

Street Address

City

State/Province

ZIP / Postal Code

SECTION 2: ELIGIBILITY & BACKGROUND

Are you currently employed?Yes (Full-time)Yes (Part-time)No

If employed, what is your current job title?

What is your current total annual household income?(Please select the range that best represents your total income before taxes.)

Highest level of education completed

Are you currently enrolled in school or training?YesNo

SECTION 3: TARGET POPULATION INDICATORS

SECTION 4: CAREER INTEREST & GOALS

What type of job are you currently seeking?Full-timePart-timeTemporaryNot sure yet

SECTION 8: PROGRAM COMMITMENT

NextUp is a 6-week career readiness program that requires consistent participation and active engagement to maximize your success. While the program provides training, resources, and support, employment is not guaranteed.

Are you able and willing to commit to attending regularly?YesNo

Preferred ScheduleMorningAfternoonEveningWeekend (Saturday)

How did you hear about this program?

SECTION 9: CONSENT & AGREEMENT

Participant Agreement & Consent

By submitting this form, I certify that the information provided is true and accurate to the best of my knowledge. I understand that providing false or misleading information may affect my eligibility for program services.

I agree to:
✔ Actively participate in program activities and workshops
✔ Conduct myself in a respectful and professional manner
✔ Work toward my employment and/or training goals

I understand that Memphis Urban League will collect and use my information for program management, reporting, and grant compliance purposes. My information will be kept confidential to the extent permitted by law.

I agree