Rockford Housing Authority Section 3 Trainee Application

Name*

First NameMiddle NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Date of Birth*

Date

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

If Under 18, Parent's Name*

Last 4 of SSN*

Do You Speak any Language(s) Other Than English?*

YesNo

What are They?*

Special Skills/Training*

Hobbies/Gifts/Talents*

Previous Training Experience*

Do You Require a Reasonable Accommodation to Perform Any of the Volunteer Tasks?*

YesNo

What is it?*

Are You Currently Employed?*

YesNo

Employer's Name*

Are You Currently a Student?*

YesNo

School's Name*

Are You a Veteran?*

YesNo

Are You a Resident of a Housing Authority or a Housing Choice Voucher Holder?*

YesNo

Do You Have a High School Diploma?*

YesNo

Do You Have a College Degree?*

YesNo

Are You Required to Complete Community Service Hours?*

YesNo

What Agency is Requiring Hours?*

How Many Hours?*

How did You Learn About the Training Program at RHA?*

Emergency Contact