The following information is required for our program funding. Please complete this to the best of your ability.
Employment Status *
- Select - Employed Unemployed Not seeking employment
Language spoken in your home: *
Goal Selection: #1 Choice *
- Select - Improve basic skills Improve English skills H.S. Diploma/HSE-GED Enter college or training Enter short-term training Military Get a Job Retain a Job Get a better job Family Goal Personal Goal Get off TANF or other Public Assistance Other Attainable goal None
If you chose "other" please enter here:
Goal Selection: #2 Choice *
- Select - Improve basic skills Improve English skills H.S. Diploma/HSE-GED Enter college or training Enter short-term training Military Get a Job Retain a Job Get a better job Family Goal Personal Goal Get off TANF or other Public Assistance Other Attainable goal None
Gender *
- Select - Male Female Non-binary
Highest year of school completed *
- Select - 0 1 2 3 4 5 6 7 8 9 10 11 12 Above 12
Previous degree/diploma
