Washington State Advanced Manufacturing Coalition USDOL Strengthening Community College's Round 5 Grant
Have you worked in manufacturing before?
No
Yes
Yes, I have working in manufacturing before
Apologies - you do not qualify
No, I have not working in manufacturing before
Please fill out the information below and submit.
Date
About You
Name (First, Middle, Last)
Social Security Number
Student ID
Date of Birth
Age at Intake
Gender
Female
Male
Other
Do you have a disability?
Yes
No
Please explain
Race (select all that apply)
American Indian/Alaska Native
Asian
Black/African American
Native Hawaiian/Pacific Islander
White
Choose to not disclose
Are you of Hispanic/Latino Ethnicity?
Yes
No
Choose to not disclose
Eligible Veteran Status
Yes, Less than or equal to 180 days
Yes, Eligible Veteran
Yes, Other Eligible Person (spouse)
No, not a Veteran
Selective Servce
Registered
Not Registered
Not Applicable
Are you authorized to work in the US?
Yes
No
Residence & Contact Information
Street Address
City
Zip Code
County
Mailing Address (if different form Stree Address)
Home or Cell Phone
Personal Email
Do you receive
TANF
General Assistance
Refugee Assistance
SNAP
Food Stamps
Other
Please note other
Employment Status at Program Entry
Employed, but not in manufacturing
Employed, but received notice of termination of employment or military separation is pending
Long Term Unemployed at Program Entry, greater than or equal to 27 consecutive weeks
Not in labor force
Unemployed
Education
High School Grade Completed at Program Entry (Grades 1-12)
Highest Educational Level Completed at Program Entry
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Contact Information