Community Development Block Grant (CDBG) CDBG & Verification Document Check List (Youth and Parent/Guardian)We are required to collect the following information as a condition of the funding that we receive from the Mayor's Office of Workforce Development (OWD). Information collected in this form is confidential and only used to verify that OWD funds benefit-eligible Boston residents. Please fill all of the information out for the participating youth. Participant First Last Youth's Pronouns*He/Him/HisShe/Her/HersThey/Them/TheirsAge Group*11-17 Years Old18-24 Years OldNeighborhood*CHARLESTOWN - 02129CHINATOWN / DOWNTOWN - 02109, 02110, 02111, 02114Dorchester/Codman SquareDorchester/Uphams CornerFENWAY - 02115, 02215HYDE PARK - 02136JAMAICA PLAIN - 02130MATTAPAN - 02126NORTH or SOUTH DORCHESTER - 02122, 02124, 02125ROSLINDALE - 02131RoxburyROXBURY - 02119, 02120, 02121Roxbury CrossingSOUTH BOSTON - 02127SOUTH END / BACKBAY - 02118, 02108, 02116WEST ROXBURY - 02132, 02167Check off all participant characteristics that apply to you and your family.NoneTAFDC RECIPIENTVETERAN STATUSDISABLEDREFUGEE/ENTRANTFEMALE-HEADED HOUSEHOLDBHA RESIDENTHOMELESSNONE OF THE ABOVEYouth Signature* By entering your name below, you hereby confirm that the information that you have provided on this form is true and accurate to the best of your knowledge. Parent/Guardian Electronic Signature (If applicable) By entering your name below, you hereby confirm that the information that you have provided in this form is true and accurate to the best of your knowledge. Income Verification*Accepted file types: jpg, png, pdf, jpeg, Max. file size: 1,000 MB.Proof of Residency*Accepted file types: jpg, png, pdf, jpeg, Max. file size: 1,000 MB.House Hold Size*1 Person2 Persons3 Persons4 Persons5 Persons6 Persons7 Persons8 Persons or more.Select the income range that best describes your household below (either column 1, 2, or 3).*Column OneColumn TwoColumn ThreeOur household income is not represented here.