Referred By:(Required) Cherry Street Mission A Renewed Mind Harbor Zepf Unison Radio Billboard Social Media Word of Mouth Other APPLICANT'S INFORMATIONName(Required) First Last Mailing Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Phone(Required)Date of Birth(Required) MM slash DD slash YYYY BREAKING DOWN BARRIERS & GETTING TO KNOW YOUDo you have a High School Diploma or GED?(Required)Your answer will not affect program eligibility. HS Diploma GED None Are you interested in support for GED prep?(Required)Your answer will not affect program eligibility. Yes No Do you have reliable transportation to attend class / employment?(Required)Your answer will not affect program eligibility. Yes No My means of transportation is:(Required) Do you need transportation assistance?(Required)Your answer will not affect program eligibility. Yes No Are you interested in mental health assistance?(Required)Your answer will not affect program eligibility. Yes No Are you interested in budgeting assistance?(Required)Your answer will not affect program eligibility. Yes No Do you have any felonies?(Required)Answering "Yes" will not disqualify you from the program. Yes No Type(Required) Are you currently employed?(Required)Your answer will not affect program eligibility. Yes No Days/Times(Required)What barriers are keeping you from being employed?(Required)Do you need temporary employment while attending Workforce Development class?(Required)Your answer will not affect program eligibility. Yes No Which class are you interested in?(Required) Auto Tech Building and Trades Culinary Customer Service Digital Literacy Manufacturing Technician Pre-GED Welding Tool and Die After you graduate, what are your career goals?(Required)Rate your computer skills(Required) Not Familiar Somewhat Familiar Very Familiar Do you enjoy working with tools mechanical in nature?(Required) Yes No Are you ready to seek employment in the vocational field of interest?(Required)Your answer will not affect program eligibility. Yes No Not Now CAPTCHA Δ
