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 JCAB Program 

   Referral 

JCAB Program Referral Form

 

Connect a young person to a community that helps them become an entrepreneur with a positive mindset. Our vision is to create a community where individuals can be economically independent and work together harmoniously. 

The Connecting The Dottes Internship Program program focuses on digital media, audio engineering, broadcasting, journalism, and marketing. Youth get real-world learning experiences and work on client-connected projects with our online TV network, Jegna Klub TV. This will help build valuable skills, establish professional relationships, and be prepared for post-secondary education and career success.

If you would like help, please contact us at 913-721-6570 or click here to complete the contact form.

Youth Photo (Optional)
Affliliations:
Items needed:

Parent/Guardian 1 (Required)

Parent/Guardian 2 (Optional)

Non-Parental/Other Contact 1 (Optional)

Non-Parental/Other Contact 2 (Optional)

Court Requirement Details- Only for youth with probation requirements.

Assigned Probation Officer

Supervisor or Other Emergency Contact

Does the youth have reliable transportation?

Your Response
NeverUsually NoUnsureUsually YesAlways

Transportation Documents

Transportation Request
Transportation Rules
Transportation Concent

What is your level of interest in Digital Media?

Your Response
No InterestLittle InterestUnsureInterestedVery Interested

What is your level of interest in Audio Engineering?

Your Response
No InterestLittle InterestUnsureInterestedVery Interested

What is your level of interest in TV/Radio Broadcasting?

Your Response
No InterestLittle InterestUnsureInterestedVery Interested

What is your level of interest in Journalism?

Your Response
No InterestLittle InterestUnsureInterestedVery Interested

What is your level of interest in Graphic Design?

Your Response
No InterestLittle InterestUnsureInterestedVery Interested

Success! The referral has been submitted. A staff member will contact the youth and guardians in 24-72 hours. 

An error occurred. Try again.

Youth Application
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