Skills to Pay the Bills Registration Form

Skills to Pay the Bills Registration Form

For students ages 14–22 who have a documented disability and live in Arizona
Diverse Ability Incorporated provides graduates of the Arizona Youth Leadership Forum (AZYLF) training opportunities designed to enhance their skills, boost their confidence, and increase their impact. Below are the details of each available opportunity.
- Arizona Youth Engagement Academy (AZYEA)
  This hands-on training helps prepare youth and young adults to assume leadership roles and provide peer-to-peer training, navigation, and support. Participants gain presentation, public speaking, and peer-to-peer facilitation skills. This course also trains participants to assist with facilitating the Person-Centered Planning process. It is open to any AZYLF graduate who has not attended previously or needs a refresher. (Please note: attendance does not guarantee paid opportunities with Diverse Ability Incorporated.)
- Person-Centered Planning Refresher
  We encourage anyone who plans to facilitate the Person-Centered Planning (PCP) process to attend a PCP Refresher Training each year. This training allows participants to learn more, discover new techniques, and share experiences with other facilitators. It is available to any AZYEA graduate looking to refresh their PCP skills and is required for anyone working with DAI to facilitate programs in schools.
- Skills to Pay the Bills (Participant)
  This practical training prepares young people for success in the workplace. It introduces them to essential interpersonal and professional skills, focusing on six key areas: Communication, Enthusiasm and Attitude, Teamwork, Networking, Problem-Solving and Critical Thinking, and Professionalism. This training is open to students aged 14 to 22 who have a documented disability and live in Arizona. Any AZYLF graduate wanting to attend the Skills to Pay the Bills Facilitator training must complete this training first. *High school, college, university, certificate program, other post-secondary training program, etc. **Documented disability may include an IEP, 504 Plan, or medical documentation of a disability or diagnosis.
- Skills to Pay the Bills (Facilitator)
  This training prepares young people to lead and facilitate the Skills to Pay the Bills curriculum and guide engaging, hands-on activities. It is available to those who have completed the Skills to Pay the Bills training as participants.
Please complete this form to register for upcoming training opportunities. If you have any questions or concerns, please email the pbs4youth inbox.
Training Selection

Please answer the following question, and the available training opportunities will be displayed.
Have you graduated from AZYLF?
I am interested in:
Please select an AZYEA training:
Have you completed the Arizona Youth Engagement Academy (AZYEA)?
You must complete the Arizona Youth Engagement Academy before you can register for this training.
Please select a Person-Centered Planning Refresher training:
Skills to Pay the Bills — Virtual Training

Skills to Pay the Bills is a fully virtual, hands-on training program designed to help young people build the interpersonal and professional skills needed to succeed in today’s workplace. Through engaging online activities, participants will learn and practice core competencies in six key areas:
- Communication
- Enthusiasm & Attitude
- Teamwork
- Networking
- Problem-Solving & Critical Thinking
- Professionalism
Who Can Participate?
This virtual program is open to students* ages 14–22 who:
- Have a documented disability**
- Live in Arizona
*Eligible students include high school, college/university, certificate program, and other post‑secondary learners.
**Acceptable documentation includes an IEP, 504 Plan, or medical documentation of a disability or diagnosis.

Program Structure
This online training requires a three‑week commitment and includes six virtual sessions, held on:

Wednesday & Thursdays
5:00 p.m. – 7:00 p.m. (Online)

September Session Dates (Virtual)
Session 1: Wednesday, September 2
Session 2: Thursday, September 3
Session 3: Wednesday, September 9
Session 4: Thursday, September 10
Session 5: Wednesday, September 16
Session 6: Thursday, September 17

Registration Deadline: August 12
Eligibility Confirmation

Please confirm that you meet the eligibility requirements to participate in Skills to Pay the Bills.
I am a student who has a documented disability. Documented disability may include an IEP, 504 Plan, or medical documentation of a disability or diagnosis.
I am 14 to 22 years of age
I am in high school or a higher education or post-secondary training program. Examples of a higher education or post-secondary training program include colleges and universities, certificate programs, or other post-secondary training programs.
I live in Arizona
I am:
We’re sorry, but you must meet all of the eligibility requirements listed above to join this training. If you have any questions or need help understanding the requirements, please feel free to email us at pbs4youth@diverseabilityincorporated.org.
Training Selection
Please select a Skills to Pay the Bills training:
Have you completed a Skills to Pay the Bills training as a participant?
You must complete the Skills to Pay the Bills training as a participant to qualify for the Skills to Pay the Bills Facilitator Training.
Please select a Skills to Pay the Bills (Facilitator) training:
Young Adult Information
First Name
Last Name
Email
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState

Zip Code
What county do you live in?
Date of Birth

MonthDayYear
Please choose the option(s) that apply to you.
Please choose the option that applies to you.
Please choose the option(s) that apply to you.
High School Student ID Number
Expected High School Graduation Date
Month and Year
Post-Secondary Program Graduation/Completion
Month and Year
Do you have a disability?
What is your disability/are your disabilities?
Are you a minor or under guardianship?
Parent/Guardian Information
Parent/Guardian Name

Parent/Guardian First NameParent/Guardian Last Name
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number

Area CodePhone Number
Accommodation Request
We are committed to making our events accessible to everyone. Please describe any disability accommodations needed to participate in this event. Note: Advance notice may be required to arrange for some accessibility needs.
Allergies and Dietary Restrictions
Please list any allergies or dietary restrictions:
Media Consent and Release
Please read the Media Consent and Release terms and conditions from Diverse Ability Incorporated and type your name in the provided space to confirm your understanding and agreement.

I acknowledge, understand, and accept, in consideration of my participation in Diverse Ability Incorporated events and activities, the following conditions:
- My activities, image, statements, and likeness may be photographed, recorded, or otherwise documented throughout the event.
- My photographs, recordings, images, and other documentation (collectively referred to as “Content”) may be utilized now or in the future for purposes such as event promotion, organizational promotion, cause-specific advancement, advertising, or other related marketing and publicity.
- The Content may be utilized on associated social media accounts, websites, brochures, flyers, recruitment materials, or included in advertising materials, whether currently known or created in the future.
- I give Diverse Ability Incorporated permission to edit, modify, copy, display, publish, or distribute the Content for any lawful purpose. Furthermore, I waive any right to review or approve the final product that features my likeness.
- I grant Diverse Ability Incorporated permission to use my first name alongside the Content with my likeness.
- I agree that I will not receive monetary or other compensation for the use of my Content in any materials now or in the future.
- I willingly give up my right to claim ownership of my image, likeness, or any related documentation, and I will not assert any intellectual property or other legal rights regarding it.
- I voluntarily agree to release any and all claims and legal remedies related to the use of my image, likeness, or otherwise, including those based on negligence. This authorization and release will also extend to the partners of Diverse Ability Incorporated.
- I agree that this release will remain valid until I revoke it in writing. I understand that any revocation will not apply to Content already posted or distributed by Diverse Ability Incorporated.
- If I wish to revoke this release at any time, I understand that I must submit a written request to Diverse Ability Incorporated. Furthermore, I know that this revocation will affect the future use of the Content, but I cannot retract Content already posted.
  - For revocation requests, please contact us via email at admin@diverseabilityincorporated.org or send mail to Post Office Box 46316, Phoenix, AZ 85063.
By typing my name, I attest that I, the participant, have read the release before signing and fully understand its contents, meaning, and implications. I acknowledge that I have the right to ask any specific questions about this release in writing before signing. I agree that my failure to do so will be seen as a voluntary and informed acceptance of its terms.
Participant First and Last Name
I am a minor or have a legal guardian:
By typing my name, I attest that I, the parent or legal guardian of the young adult named above, have read the release before signing and fully understand its contents, meaning, and implications. I acknowledge that I have the right to ask any specific questions about this release in writing before signing. I agree that my failure to do so will be seen as a voluntary and informed acceptance of its terms. (Required if the participant is under 18 or legal guardianship.)
Parent/Guardian First and Last Name
Optional Funding Questions

These questions are for funding and grant purposes. You can choose to answer them or not; either way, it will not affect how we consider your application. If you do answer, your responses will help Diverse Ability Incorporated continue to provide free and low-cost programs for youth and young adults who have disabilities. Your answers are confidential, meaning we will not connect your name or any other part of your application to your responses. Thank you for your support!
Based on your household income, are you eligible for low-income assistance programs (e.g., Free and Reduced-Price School Meals, Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), Food Distribution Program on Indian Reservations (FDPIR), etc.)?
Do you have a physical disability or a chronic health condition?
If you answered “Yes,” please check all that apply.

Other
If you have difficulty completing this online form, please email us or call 602-425-5135.
Should be Empty:

Skills to Pay the Bills Registration Form

Training Selection

Young Adult Information

Parent/Guardian Information

Accommodation Request

Allergies and Dietary Restrictions

Media Consent and Release

Optional Funding Questions