I have the following barrier(s):


Barrier Documentation
Resident of the City of San Bernardino ·      California Identification

·      Utility

·      Voter Registration card

·      Postmarked envelop

Disabled / Special Education / Serious emotional / medical / psychological problems ·      School record (IEP or 504 Plan)

·      Doctor’s note or Medical record or Psychological Evaluation

·      Vocational Rehabilitation letter/statement

·      Social Security disability records

·      Psychiatrist or psychologist diagnosis or statement

Foster or Aftercare Youth /Emancipated ·      Placement documents

·      Documentation from ILP

Basic Skills Deficient


·      Below 9th grade in Reading or Math as determined by test performed by Youth Action Project staff

·      High School Diploma / GED certificate

·      Must qualify as Low Income along with copy of HS Diploma/GED

Limited English Language Proficiency / ESL


·      School records must be recent (or of last year attended for those out of school)

·      Must qualify as Low Income along with school documentation

Offender or Child of Incarcerated parent


·      Record of Arrest and Prosecution (RAP Sheet)

·      Probation papers

·      Court documents Letter from Attorney

Substance Abuse


·      Record of Arrest and Prosecution (RAP Sheet)

·      Rehabilitation agency letter/statement

Pregnant or Parenting


·      This applies to an applicant who is a Mother or Father

·      Birth certificate of child with applicant’s name as parent (May use Hospital record of birth, does not need to be certified)

·      Medical record or Doctor’s note



·      Written statement from Shelter or Social Service Agency

·      Written statement from an individual providing temporary residence

Gang affiliation or at risk of gang affiliation ·      Documented by school official or police department indicating gang activity