Workforce Empowerment Initiative Program Application
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Student KCID
Email
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Second Number
Please enter a valid phone number.
Format: (000) 000-0000.
What is your preferred method of communication?
*
Call
Text
Email
Do you identify as having a disability?
No
Yes – Physical
Yes – Mental Health
Yes – Learning
Yes – Multiple Disabilities
Prefer not to say
Are you a first-generation student?
*
Yes
No
Are you a U.S. military veteran?
*
Yes
No
Have you ever been impacted by the criminal justice system? (e.g., arrested, incarceration, probation)
*
Yes
No
Do you drive?
*
Yes
No
Do you own a car?
*
Yes
No
Do you have a driver’s license?
*
Yes
No
Do you use public transportation?
*
Yes
No
What barriers do you currently face? (check all that apply)
Lack of transportation
Mental health/Substance use/Medical
Lack of childcare
Housing stability
Criminal background
Food insecurity
No high school diploma or GED
Language barrier
Low literacy or math skills
Technology access
Other
Current employment status
*
Unemployed
Employed part-time or underemployed
Employed full-time
Do you plan to seek employment or career advancement after the program?
*
Yes
No
Unsure
What type of employment are you seeking after completingthis program? (check all that apply)
*
Full-time employment
Part-time employment
Start my own business
Advance in current job
Explore career options
Other
If employed, where do you work?
*
Hourly wage or salary:
*
Household Size:
*
What is your work schedule?
*
Current Source(s) of Income or Assistance (check all that apply)
*
Wages from employment
Unemployment benefits
VA Disability
Workman’s Compensation
Pension/Retirement
SSI/SSDI
Food stamps/SNAP/TANF
WIC
Medical card/Medicaid MCO
Federal free/reduced school lunch
No income
Highest level of Education attained
*
Some High School
High School Diploma
GED
Some College
College Degree
College Certificate
Associate’s or Bachelor’s degree or higher level
Program of Interest
*
Basic Builder/Carpentry
Certified Nursing Assistant (CNA)
Licensed Practical Nursing (LPN)
HVAC
Industrial Technology
Manufacturing Technology
Truck-driving (CDL)
Welding
How did you hear about the WEI program?
*
WEI Staff
KC/WEI Student
160 Driving Academy
Family/Friend/Co-Worker
Facebook/Instagram/Other social media
Other
Date
*
-
Month
-
Day
Year
Date
Submit
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