Program Application
What program are you applying for?
Please Select
BCST (Basic Computer Skills Training)
ICST (Intermediate Computer Skills Training)
MOST (Microsoft Specialist Training)
POST (Professional Office Skills Training)
QBOT (QuickBooks Online Training)
Next Level
Name
*
First Name
Last Name
What is your gender?
*
Female
Male
Transgender Female
Transgender Male
Gender Variant/Non-Conforming
Prefer Not to Answer
Other
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
*
Please Select
Fort Worth
Aledo
Arlington
Azle
Bedford
Benbrook
Blue Mound
Burleson
Colleyville
Coppell
Crowley
Dallas
Eagle Mountain
Edgecliff Village
Euless
Everman
Grand Prairie
Grapevine
Haltom City
Irving
Keller
Kennedale
Lake Worth
Mansfield
Melody Hills
Mesquite
North Richland Hills
Pantego
Richland Hills
River Oaks
Saginaw
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Westover Hills
White Settlement
Other
City
State
*
Please Select
Alabama
Alaska
Arizona
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California
Colorado
Connecticut
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District of Columbia
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South Dakota
Tennessee
Texas
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Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
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State
Zip Code
*
Zip Code
What is your current country of residence?
*
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Marital Status
*
Please Select
Single
Living with Partner
Married
Separated
Widowed
Divorced
How did you hear about The Ladder Alliance?
*
Please Select
ACH
Catholic Charities
Childcare Assiciates
Community Enrichment
DARS
DB Shankers
Depression Connection
F.A.C.T.
Fort Worth Housing Authority
Friend/Family
FWHA - Fort Worth Housing Authority
HeadStart
HOPE Farm
Internet
JPS
Lake Como Community Center
MHMR
ODWIN-Opening Doors for Women in Need
One Safe Place
Richard J. Wilson Elementary
SafeHaven
SER
Shelter Fairs
Social Media
Tarrant County Housing
Tarrant County College
Texas Christian University
Texas Christian University - TRIO
Texas Workforce
The Ladder Alliance
The Parenting Center
Union Gospel Mission
Western Hills Primary
WFF Campus
Women's Center
Other
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Do you identify as Hispanic or Non-Hispanic?
*
Hispanic
Non-Hispanic
What is your race?
*
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Multi-Racial
Middle Eastern
What is your current employment status?
*
Unemployed
Part-Time
Full-Time
Self-Employed
Other
What is your hourly pay rate?
Less than $15 per hour
Between $15 and $20 per hour
More than $20 per hour
What is your total household income?
Please Select
Less than $10,000
$10,000 to $19,999
$20,000 to $29,999
$30,000 to $39,999
$40,000 to $49,999
$50,000 to $59,999
$60,000 to $69,999
$70,000 to $79,999
$80,000 to $89,999
$90,000 to $99,999
$100,000 to $149,999
$150,000 or more
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Emergency Contact
Emergency Contact Name:
*
Emergency Contact Relationship:
*
Emergency Contact Phone Number:
*
Please enter a valid phone number.
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Other Information
What is YOUR highest level of education?
*
Elementary School
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
High School Diploma
GED
Some College
Associate's Degree
Bachelor's Degree
Master's Degree
Doctorate
Primary Language
*
Please Select
English
Spanish
Other
Are there any other languages spoken in your household? (check all that apply)
*
English
Spanish
Arabic
Mandarin
Cantonese
Vietnamese
Tagalog
Urdu
French
Hindi
Korean
German
N/A
Other
Describe your current housing situation:
*
Own home
Renting
Living with family
Living with friends
In between housing
Living in shelter
Homeless
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Other Information cont.
Please check all barriers you feel are preventing you from obtaining and/or keeping a job: (check all that apply)
*
Child care
Improper clothes
Criminal history
Marketable skills
Transportation
Need coaching on job interviews
Never had a job before
Poor attendance
Unstable work history
Excessive tardiness
Family/friends
N/A
Other
Are you a Family Member or Member of the U.S. Armed Forces, Reserve, or national Guard
*
Yes
No
Please classify your affiliation (select any that apply):
*
Veteran
Active Duty
Dependent
Spouse
Other
Do you consider yourself a member of the Lesbian, Gay, Bisexual and/or Transgender (LGBTQIA+) community?
*
Yes
No
No, but I identify as an Ally
Prefer not to say
Do you presently, or have you ever suffered from any of the following Mental Health Disorders/Illnesses:
*
Depression
Anxiety
Post-Traumatic Stress Disorder
Bipolar Disorder
Attention Deficit Hyperactivity Disorder
Obsessive-Compulsive Disorder
Autism Spectrum
N/A
Other
Have you ever been incarcerated? (This question does not determine your eligibility & responses are confidential)
*
Yes
No
Please explain:
*
Felony Assault Charge
Sexual Assualt Charge
Other
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Ladder Alliance Mission
The mission of The Ladder Alliance is to serve, in particular, women of domestic violence and those that are at risk. Since many of the agencies we work with do not necessarily serve this population, we are asking you to share with us whether you are currently involved in or have ever been involved in either a physically or mentally abusive relationship. (This information is kept confidential)
*
Please Select
Yes
No
Unsure
Photography Release
There are times when we publish photographs of our students, for instance in an agency newsletter. We know there are those prospective students that do not want their photo published. May we use your photography?
*
Please Select
Yes
No
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