Information Session Registration

Please Select a Wednesday For Your 1-Hour Information Session Attendance Date (required)
---April 4, 2018April 11, 2018April 18, 2018April 25, 2018May 2, 2108May 9, 2018May 16, 2018

Anticipated Program Start Date (required)
---February 5, 2018April 23, 2018Other (specify below in comments box)

First Name (required)

Last Name (required)

Phone (required)

Email (required)

Program Interest
---Construction GED Training ProgramHealthcare GED Training ProgramPre-Apprentice ConstructionCarpentryElectricianCommunity Health Worker (CHW)Medical Administrative AssistantSenior Care CNA/CHW

Barriers (Please select any that apply)

No Barriers

Abuse

Child Care

Clothing

Drug/Substance Abuse

Financial Instability

Health Issues

Housing

Court Appearances

Relationship Issues

Transportation

How did you hear about us? (Please select any that apply)

KSTC (Channels 12/45)

WFTC (Channels 10/29)

CW (Channels 8/23)

KMSP

Pandora

KMOJ

Hot 102.5

KDWB

Outdoor Billboard

Banner

Newspaper

Event

Flyer/Brochure

Facebook

Instagram

Twitter

YouTube

LinkedIn

Internet Search

Mobile App Ad

Desktop Ad

Referred By (Please select any that apply)

Family/Friend

Summit Student/Alumni

Religious Institution

Organization

Workforce Center

STS/Corrections

Hennepin County

Ramsey County

Parole Officer

Job Fair

The following questions are optional:

Which gender do you identify as?

---MaleFemaleNon-Binary

What is your Race? (select all that apply)

White
Black
African American
Native American/Alaskan Native
Asian
Pacific Islander/Native Hawaiian

What is your Ethnicity?

---Hispanic or LatinxNon-Hispanic or Non-Latinx

What is your age?

---18-2425-3435-4445-5455+

Comments:

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