Workforce Empowerment Initiative Program Application (WEI)

Workforce Empowerment 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
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?*

CallTextEmail
Do you identify as having a disability?

NoYes – PhysicalYes – Mental HealthYes – LearningYes – Multiple DisabilitiesPrefer not to say
Are you a first-generation student?*

YesNo
Are you a U.S. military veteran?*

YesNo
Have you ever been impacted by the criminal justice system? (e.g., arrested, incarceration, probation)*

YesNo
Do you drive?*

YesNo
Do you own a car?*

YesNo
Do you have a driver’s license?*

YesNo
Do you use public transportation?*

YesNo
What barriers do you currently face? (check all that apply)

Lack of transportationMental health/Substance use/MedicalLack of childcareHousing stabilityCriminal backgroundFood insecurityNo high school diploma or GEDLanguage barrierLow literacy or math skillsTechnology accessOther
Current employment status*

UnemployedEmployed part-time or underemployedEmployed full-time
Do you plan to seek employment or career advancement after the program?*

YesNoUnsure
What type of employment are you seeking after completingthis program? (check all that apply)*

Full-time employmentPart-time employmentStart my own businessAdvance in current jobExplore career optionsOther
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 employmentUnemployment benefitsVA DisabilityWorkman’s CompensationPension/RetirementSSI/SSDIFood stamps/SNAP/TANFWICMedical card/Medicaid MCOFederal free/reduced school lunchNo income
Highest level of Education attained*

Some High SchoolHigh School DiplomaGEDSome CollegeCollege DegreeCollege CertificateAssociate’s or Bachelor’s degree or higher level
Program of Interest*

Basic Builder/CarpentryCertified Nursing Assistant (CNA)Licensed Practical Nursing (LPN)HVACIndustrial TechnologyManufacturing TechnologyTruck-driving (CDL)Welding
How did you hear about the WEI program?*

WEI StaffKC/WEI Student160 Driving AcademyFamily/Friend/Co-WorkerFacebook/Instagram/Other social mediaOther
Date*

MonthDayYear
Date
Should be Empty: