Workforce Equity Initiative Program Application

Workforce Equity Initiative Program Application
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Student KCID
Email
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your preferred method of communication?*

CallTextEmail
Please indicate your primary ethnic/racialgroup (select one):

AsianAmerican Indian or Alaska NativeBlack or African AmericanWhiteNonresident AlienNative Hawaiian or Pacific IslanderPrefer not to disclose
Hispanic or Latino Ethnicity

YesNoPrefer not to disclose
Disability Status

Not disabledPhysical ImpairmentMental ImpairmentLearning ImpairmentMultiple DisabilitiesPrefer not to disclose
Phone Number*
Please enter a valid phone number.
Second Number
Please enter a valid phone number.
I am receiving income and/or benefits from one or more of the following:

Wages from jobUnemploymentSSI/SSDIFood stamps/SNAP/TANFWICMedical card/Medicaid MCONo income at this timeFederal free lunch programOther
If you are working, where are you employed?
If you are employed, what is your salary/hourly wage?
Household Size:
Annual Household Income:
Highest level of Education attained

Some High SchoolHigh School DiplomaGEDSome CollegeCollege DegreeCollege CertificateOther
Program of Interest

Basic Builder/CarpentryCertified Nursing Assistant (CNA)HVACIndustrial TechnologyTruck-driving (CDL)WeldingOther
Explain your education goals:
Explain your career goals:
If you meet eligibility requirements and are accepted into the program, please list possible resources you may need assistance with or would like more information:

TransportationChildcareMortgage/Rental AssistanceMedical AssistanceFood Assistance/Food PantriesMental Health/Substance Use ServicesEmployee Support ServicesTechnology Assistance (Laptop, Internet)
How did you find out about the WEI program?*

WEI RecruiterWEI StudentFamily/Friend/Co-WorkerFacebook/Instagram/Other social mediaNewspaperOther
Date*

MonthDayYear
Date
Should be Empty: