Student Intake Form First Name * Last Name * Email * Zip Code Preferred Name Phone Emergency Contact How did you hear about us? Cohort Start Date Date of Birth Gender -None- Male Female NA Race / Nationality -None- Black or African American White or Caucasian Native American Hispanic / Latino Asian Native Hawaiian or Other Pacific Islanders Non- Hispanic Marital Status -None- Single Married Separated Divorce Widow Do you have a valid Drivers License? -None- Yes No Education -None- GED/Highschool Some College Vocational Certificate Associates Degree Bachelor Degree Graduate Degree Did not finish High School Are you a Military Veteran? Do you have Children? If yes, How many? Housing Status Own Rent Family/ Friends Shelter Homeless Income Under 24,999 25,000-49,999 50,000-74,999 75,000-99,999 100,000-149,999 Household size? Have you ever worked in Construction? What trades are you interested in? Welding Plumbing Pipe Fitting Electric Flagging Site Safety Operations HVAC Masonry Carpentry Heavy Equipment Operator Are you eligible to work in the United States? > Have you ever been convicted of a felony? Are you currently on probation?
