Google Android Developer Certificate Program

Google Android Developer Certificate Program

Division of Workforce & Professional Development Learner Application
Name *

First Name Middle Name Last Name
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
County of Residence
Phone Number *

Area Code Phone Number
Date of Birth *

Month Day Year
Date
E-mail *
Are you a resident of Maine? *

Yes No
Are you a US citizen? *

Yes No
Ethnic Group *

Not Hispanic/Latino Hispanic/Latino
Race *

American Indian or Alaska Native Asian Black or African American White Native Hawaiian or Other Pacific Islander
Gender *

Male Female Other
Education (highest grade completed) *

Less than HS Diploma, GED, or HiSet HS Diploma, GED, or HiSet Some college/no credential Associate's degree Bachelor's degree Master's degree or higher
Are you currently employed? *

Yes No
Who is your employer? *
Have you been negatively, economically impacted my Covid-19?

Yes No
How did you hear about this course? *

Newspaper Email Newsletter Facebook Word of Mouth
Do you agree to receive SMS text messages regarding the course?

Yes No
Please upload proof of your Covid 19 vaccination.

Browse Files

Cancel of
I certify that all information on this application is accurate and complete. I also give WCCC permission to access my State of Maine Driving Record.
Signature *

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