IT Training and Apprenticeship Program

Today’s Date*

First Name*

Last Name*

Phone Number*

Email*

City*

What is your age? (Some of our programs have age restrictions. This helps us determine what services you may qualify for)*

Are you currently enrolled in school?*

Yes

No

Degree program, if any*

Education Institution*

Year graduated (or expected graduation date)

Have you been convicted of any crimes? (please note, crimes do not necessarily exclude anyone)*

Yes

No

What is your transportation situation? Do you own a car? Do you take the bus?*

What is your housing situation?*

Describe your previous IT experience or interest in the field. *

If you have completed any other IT certification besides those listed, please let us know here:*

Employment Status*

working full-time

working part-time

not working

If employed or underemployed, please explain your current situation*

If you are not employed, what is your last date of employment? When did your last job end?*

Are you a military veteran/currently enlisted?*

Yes, I am a veteran or I am currently enlisted

No, I was never in the military

Do you have a security clearance?*

Yes

No

Not Sure

Do you have a disability? *

Yes

No

Unsure

What kind of job are you looking for upon completion of certification?*

How do you plan to advance your career with this program?*

What is your availability for class? Please mark all options that you are available for and interested in.

Morning (Currently not offered- contingent on demand)

Afternoon Mon/Tues

Afternoon Wed/Thurs

Evening

Online (CYSA+/ Sec+ starting in March – Currently not offered for A+ – Contingent on demand)

Where did you hear about our Program? *

Please upload a copy of your most recent resume (Must be PDF)*

IT Training and Apprenticeship Program

A-DA Programs