FINANCE Information Form
Please fill out the following information and one of our training program coordinators will contact you within the next 72 hours.
This program is only for Dane County, Wisconsin Residents.
*Answering all questions is required.
Full Name
*
First Name
Last Name
Today's Date
-
Month
-
Day
Year
Date
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
How did you find out about the program?
*
Facebook,
LinkedIn
Instagram
La Movida
Radio, Flyer
Word of Mouth
Family or friend referral
Returning client
Referred by another organization
Centro's Website
Via - QR Code
Other
What is your age?
*
Which city do you live in?
*
Which county do you live in?
*
What's your race/ethnicity?
*
Black/African American
American Indian and Alaskan Native (Cherokee, Chippewa, Navajo, Sioux)
Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Hmong, Other Asians)
Native Hawaiian and Other Pacific Islander (Guamanian, Chamarrow, Saamoan)
Two or more Races
Hispanic/Latino (Mexican, Puerto Rican, Cuban and other Hispanic or Latino)
White, Not Hispanic or Latino
From the following list, please check the items that apply to you:
Completed High School or GED/HSED Diploma
Completed High School in the country of origin (must have access to original documents)
18 years or older
Authorized to legally work in the United States
English Language Learner at an Intermediate or Advanced Level
If you’re a male between the ages of 18 and 25, have you registered for SelectiveService?
Yes
No
Unsure
Please indicate your English level:
Beginner
Intermediate
Advanced
Have you taken the Accuplacer (Reading 60+) test within the last 2 years, or Accuplacer New-Generation (Reading 240+) test this year at Madison College?
Yes
No
Unsure
Please attach your most recent Accuplacer Test results during the last two years in PDF format (if applicable).
Browse Files
Cancel
of
If you recently graduated from High School, did you take the ACT test (Reading 13+)?
Yes
No
Unsure
If you’re looking for a training in a differentfield, please specify:
Submit
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