Application for Accelerated Career Training (ACT) Program

Application for Accelerated Career Training (ACT) Program

We are accepting applications for the following Spring 2025 classes: CDL Truck Driving, Culinary, Early Childhood Education, Basic Auto Repair. All other classes are full for Spring 2025.
YOUR INFORMATION
Entry Status*
Are you currently on financial aid?*

YesNo
What's your student ID number? (If you do not know, please enter 000.)*
Have you been on academic probation?*

YesNo
Full Legal Name*

PrefixFirst NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Primary Phone*

Area CodePhone Number
Alternate Phone

Area CodePhone Number
Email Address*
example@example.com
Age*
Gender

FemaleMaleIdentify Differently
Ethnicity

Hispanic/LatinoNon-Hispanic/Latino
Race
State of Legal Residence:*

North CarolinaOther
Approximately when did you move to NC? *

MonthDayYear
Date
U.S. Citizen?*
Are you authorized to work in the U.S.?*

YesNo
Is English your primary language?*

YesNo
What is your primary language?*
Current Employment Status*
What is your current job title and company name? *
Position, Company
What was your last position title, company name, & dates of employment? *
Position, Company, Date
What is your current Monthly Gross Income (Individual)*
Please share estimated personal monthly income before taxes.
What is your current Monthly Gross Income (Household)*
Please share estimated combined household income before taxes.
How many dependents do you have? *
(typically children who live with you)
Total household size (including yourself)*
(how many people are in your household for tax purposes)
Highest Education Level*
Please choose program area of interest:*

CDL/Truck DrivingEarly Childhood EducationHVACInformation Technology FundamentalsNurse Aide/CNALine Cooking Fundamentals (Food Truck)PhlebotomyEmergency Medical Technician (EMT)Basic Automotive TechFundamentals of Food (Culinary)Electrical Lineworker
Do you have a valid NC driver's license? (required for CDL)*

YesNo
Do you have reliable transportation? (Access to bus is acceptable)*

YesNo
The following programs require a drug screen and/or background check to enter the program or for employment:
- HVAC
- Phlebotomy
- CNA/Nurse Aide
- CDL
- Early Childhood Education
- Emergency Medical Technician
Are you able to pass a criminal background check?*

YesNo
Please upload your most recent resume.

Browse Files

Cancelof
Tell us about your career goals and how the ACT Program can help you reach them? (please provide a thoughtful answer) *
REFERENCES

To be considered for this program, please provide the name, valid e-mail address and phone number for someone who will be able to send us a reference letter (e.g. former employer, mentor, etc. - NOT a family member). Following the submission of this form, they will recieve an email with a link to provide/upload their reference letter.
Reference Name*

First NameLast Name
Reference Email*
example@example.com
Reference Phone Number*

Area CodePhone Number
Do you receive Food and Nutrition Services in Mecklenburg County? (Ex: EBT, food stamps) This may allow us to provide additional funds and resources.*

YesNoNot at this time, but I think I am eligiblePrefer not to answer
Please Share With Us How You Learned About the Program

Friend or FamilyCommunity ReferralAdvising/CounselingCPCC EmployeeFlyerNC WorksInternet SearchSocial Media (e.g. Facebook)Other
SIGN, REVIEW & SUBMIT

I certify that the above information is true and accurate.
E-Signature*

Clear
Click Preview Answers to review your application before submitting.
Your application does not automatically insure that you will be chosen for the Accelerated Career Training Program. This application does not constitute a legal contract. Other information may be required to determine eligibility. This application is subject to revision. Eligibility and requirements are subject to change without notice. Applicants will not be notified of any changes in the application or the application process. It is each applicant’s responsibility to insure that he or she has a current and up-to-date application.

*Applicant’s Ethnic Group: Ethnic identification is required by the Office of Civil Rights of the Department of Health, Education, and Welfare to assure compliance with the Civil Rights Act. Ethnic origin is not a factor in consideration for scholarship awards; all applicants are considered without reference to creed or race.

If you are experiencing technical issues submitting your application, please call (704) 330-6975 or email act@cpcc.edu

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