Eligibility & Application Form To apply to RiseUp, complete and submit the eligibility form below. A team member will be in touch with you to discuss the program and the next step! Your Name* Phone*Email* Are you 17 years of age or older?* Yes No Do you identify as female?* Yes No I am Unemployed* Yes No “Unemployed means you are available for work but do not have work and includes those: who are on temporary layoff with an expectation of recall, have actively looked for work in the past four weeks or have a new job to start within four weeks.” If employed, I am working less than 30 hours a week, on average.* Yes No If you are working, do not quit your job as this may affect your eligibility for the program.I am receiving Employment Insurance.* Yes No I am on Income Assistance* Yes No I have a self-identified or diagnosed disability* Yes No I am legally entitled to work in Canada.* Yes No I am currently living on Vancouver Island.* Yes No You must provide two pieces of ID to verify; one piece must be Photo ID.What city do you live in? I am currently a full-time student or enrolled in high school.* Yes No I am currently participating in another government-funded program.* Yes No Name of Program: Have you applied to any other ETHOS programs?* Yes No Name of Program: How did you learn about RiseUp?*I have access to a computer* Yes No I have access to a webcam* Yes No HiddenDate Submitted (DD/MM/YYYY)
