Form DI-4014 YCC Application Form

Form DI-4014 (Rev. 07/2023)
U.S. Department of the Interior

OMB Control No. 1093-0010
Expires XX/XX/20XX

UNITED STATES YOUTH CONSERVATION CORPS
MEMBER APPLICATION

PROGRAM OVERVIEW
The United States Youth Conservation Corps (YCC) is a summer youth employment program that
engages young people in meaningful work experiences on national parks, forests, wildlife refuges,
and fish hatcheries while developing an ethic of environmental stewardship and civic responsibility.
YCC members work on projects that promote awareness and appreciation of the public lands legacy
and the nation’s natural, cultural, and historic resources.
The YCC is administered jointly by the U.S. Department of the Interior – National Park Service and Fish and
Wildlife Service and the U.S. Department of Agriculture – U.S. Forest Service. Housing is not provided
unless the specific YCC site/program has clearly indicated that their program provides housing.
ELIGIBILITY REQUIREMENTS
Applicants must:
 Be at least 15 years of age at the start of enrollment and must not reach age 19
before completion of the program
 Be a US citizen or permanent resident of the United States, its territories, or its possessions
 Provide or be able to obtain a work permit as required under the laws of the applicant’s home
state
 Provide a valid U.S. Social Security number or have applied for a valid Social Security number
 Be able to fulfill the essential functions of the assigned work with or without a reasonable
accommodation
 Be actively committed and willing to complete the assigned work project
PROGRAM BENEFITS
The YCC affords members a variety of opportunities to work on projects, such as constructing and
repairing trails, preserving and repairing historic buildings, removing invasive species, assisting with
wildlife and land research, leading environmental education programs, and supporting agency staff.
HOW TO APPLY
For more information on how to apply to YCC programs and opportunities, please visit agency
webpages for locations, application process, due dates, and points of contact. Eligible applicants
should follow the instructions for completing and submitting the application as directed by YCC
program sites. Applicants may also contact the nearest YCC program office managed by the National
Park Service, U.S. Fish and Wildlife Service, or U.S. Forest Service for more information.
Please visit the following sites for YCC opportunities:
• National Park Service: https://www.nps.gov/subjects/youthprograms/ycc.htm
• U.S. Fish & Wildlife Service: https://fws.gov/youth-conservation-corps
• U.S. Forest Service: https://www.fs.usda.gov/working-with-us/opportunities-for-youngpeople/youth-conservation-corps-opportunities
Please fill out this application as thoroughly and legibly as possible. Submit the completed application to
the Youth Conservation Corps (YCC) program site location where you would like to work using the YCC
mail or email address listed on the Federal agency’s website.

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Form DI-4014 (Rev. 07/2023)
U.S. Department of the Interior

OMB Control No. 1093-0010
Expires XX/XX/20XX

UNITED STATES YOUTH CONSERVATION CORPS
MEMBER APPLICATION
This application must be filled out completely to determine the applicant’s eligibility and availability.
Incomplete applications may be rejected. Complete applications include responses to all questions
(unless marked optional), parent/guardian contact information, and certification signatures. Eligible
applicants are randomly selected to fill open YCC member positions.

Tell Us About Yourself
Please answer the following questions regarding your background, contact, and other information.
Contact Information
1. Name: First: __________________
2. Gender

 Male

3. Date of Birth

 Female

mm/dd/yyyy:

Middle: _________________

 Self-identify as

 Non-Binary

 Prefer not to disclose

_______________________
/

Age ________

/

4. Address: ____________________________
5. Email _____________________

Last: ________________________

City ________________

Phone 1: ________________

State: _______ Zip _______

Phone 2: ____________________

6. What is the best way and time to contact you? ________________________________________________
7. What YCC site are you applying? Note that a separate application needs to be completed for each site you
are applying to. Please specify the session dates if known. Some sites may have more than one session
offered, which may be noted on the site’s YCC opportunities page.
___________________________________________________________________________________
8. Applicants are required to provide their own housing in the local area unless the YCC announcement clearly
states that housing is provided as part of the program. Do you currently have housing in the local area from
which you can commute each day?
 Yes

 No

 N/A: The YCC site has clearly indicated that housing is provided.

If you do not currently have housing, explain your plans for obtaining housing if offered the position. Please note
that finding short-term rentals in communities near public lands is often extremely difficult and sometimes does not
exist.

_________________________________________________________________________________

9. How did you learn about the YCC program? (Select all that apply)
 Website
 Poster

 Past/Current YCC Member  School Counselor/School Newspaper/School Newsletter
 Federal Staff Member  Online Job Board  Social Media  Other ________________

Other Information
10. Are you able to perform work that is physically strenuous and in adverse weather conditions such as rain or
heat?
 Yes  No
11. Will you require a reasonable accommodation (modification or adjustment to a job, the work environment, or
the way things are usually done) to perform work that may be assigned to you?
 Yes
 No

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Form DI-4014 (Rev. 07/2023)
U.S. Department of the Interior

OMB Control No. 1093-0010
Expires XX/XX/20XX

UNITED STATES YOUTH CONSERVATION CORPS
MEMBER APPLICATION
12. If you answer “no” to question #1, or “yes” to question #2, tell us what types of work you are unable to
perform and/or describe the types of accommodations you may need to work in the outdoors or otherwise.

13. Are you a current YCC member or have you served as a YCC member in the past?  Yes
If yes, where: ______________________________________________

 No

When: ____________________

Briefly describe the project(s) or work you performed:
_____________________________________________________________________________________
_____________________________________________________________________________________

14. Tell us why you want to join the YCC. Optional. Your answer will help the YCC site understand what you
hope to get out of the position and how they can provide a positive YCC experience for you. Since selection is
random, your response will not be used in the selection process. You may choose not to respond to this
question.
In 250 words or less, please explain why you want to serve as a YCC member

15. Additional Information

Please use this section to answer questions or to include more information to submit a complete YCC
application. This section is optional and may be skipped if the applicant has no further information to share

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Form DI-4014 (Rev. 07/2023)
U.S. Department of the Interior

OMB Control No. 1093-0010
Expires XX/XX/20XX

UNITED STATES YOUTH CONSERVATION CORPS
MEMBER APPLICATION
16. CERTIFY YOUR APPLICATION
I am familiar with the Youth Conservation Corps (YCC) program and am interested in working to develop and maintain the
natural and cultural resources of the United States.
I certify that I understand the work and environmental conditions that might exist while serving as a YCC member. I
understand that I may be exposed to physical work, insects, poison oak and ivy, adverse weather, and outdoor working
conditions up to eight hours a day during service, depending on the type of YCC position.
I certify that I meet all YCC program eligibility requirements. I am a citizen or permanent resident of the United States or its
territories or its possessions. I have or am applying for a valid U.S. Social Security number. I will be at least 15 years of age
on or before the first day of work and will not reach 19 years of age before completion of the program. And finally, if selected,
I will obtain a work permit, if required.
I certify that all information I have provided on this application is true and correct to the best of my knowledge.
I understand that incorrect statements constitute grounds for immediate dismissal. With my signature, I certify that I give my
permission for this form to be reviewed by any YCC official.
___________________________________ ________________________________________________ ____________
Applicant Name
Applicant Signature (digital signature is acceptable)
Date (mm/dd/yyyy)

For applicants under the age of 18:
By signing this document, I, the parent/legal guardian of the above applicant, acknowledge that I have discussed the YCC
program with the applicant. I give permission for the applicant to apply for and participate in the YCC program, if selected.

___________________________________

________________________________________

___________

Parent/Legal Guardian Name

Parent/Legal Guardian Signature (digital signature is acceptable)

Date (mm/dd/yyyy)

__________________________________
Phone Number

____________________________________________________________________
Email Address

References
Please provide four references who know you well, such as teachers, coaches, or religious leaders. At least two
references must be people who are not related to you. Complete all information requested.
Reference 1
First Name: ___________________________________

Last Name: _________________________________

Relationship to Applicant _________________________

Phone: _____________________________________

Reference 2
First Name: ___________________________________

Last Name: _________________________________

Relationship to Applicant _________________________

Phone: _____________________________________

Reference 3
First Name: __________________________

Last Name: _________________________________

Relationship to Applicant ________________

Phone: _____________________________________

Reference 4
First Name: __________________________

Last Name: _______________________

Relationship to Applicant ________________

Phone: _____________________

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Form DI-4014 (Rev. 07/2023)
U.S. Department of the Interior

OMB Control No. 1093-0010
Expires XX/XX/20XX

UNITED STATES YOUTH CONSERVATION CORPS
MEMBER APPLICATION

NOTICES
PRIVACY ACT STATEMENT
Authority: 16 USC 1701-1706, Chapter 37 – Youth Conservation Corps and Public Lands Corps, Subchapter I –
Youth Conservation Corps (Youth Conservation Corps Act of 1970 (P.L. 91-378; 84 Stat. 794) as amended in
1972 (P.L. 92-597) and in 1974 (P.L. 93-408).
Purpose: The information is collected to evaluate the eligibility of youth 15-18 years of age for employment with the
Youth Conservation Corps (YCC).
Routine Uses: The information collected on this form may be shared in accordance with the Privacy Act of
1974 and the routine uses listed in the DOI Office of the Secretary (OS) System of Records Notices
INTERIOR/OS-25, YCC Enrollee Records, and INTERIOR/OS-29, YCC Recruitment Files available at
https://www.doi.gov/privacy/os-notices.
Disclosure: Furnishing this information is voluntary; however, failure to provide the requested information may
disqualify acceptance into the YCC program.
PAPERWORK REDUCTION ACT STATEMENT
In accordance with the Paperwork Reduction Act (44 U.S.C. 3501), the U.S. Department of the Interior National Park
Service and U.S. Fish and Wildlife Service, and the U.S. Department of Agriculture – U.S. Forest Service to collect
information necessary to assist the agencies in safeguarding the health, safety, and welfare of the enrollees of the
YCC programs. Your response is voluntary, but failure to complete this form may result in exclusion from
participation in the YCC program. According to the Paperwork Reduction Act of 1995, an agency may not conduct or
sponsor and a person is not required to respond to a collection of information unless it displays a currently valid OMB
control number. OMB has approved this collection of information and assigned Control No. 1093-0010.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information to average 25 minutes, including time for reviewing
instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the
burden estimate or any other aspect of the form to the Departmental Information Clearance Officer, U.S. Department
of the Interior, 1849 C Street, NW Washington, DC 20240, or via email at [email protected]. Please do not send
your completed form to this address

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