LCEWD Training Interest Form

Economic and Workforce Development is committed to providing accessibility for everyone. If you need assistance completing this form, reach out to Blake Dowling at lcewd-ada@larimer.org or via phone at 970.498.6041.
LCEWD Training Interest Form

Form Revised 02.23.24
Thank you for taking the initial steps in connecting to training services at Larimer County Economic and Workforce Development (LCEWD).

LCEWD offers a wide variety of programs and services to help customers connect to resources.

Please be sure you are registered in Connecting Colorado in order for us to process your Training Interest Form.

If you are primarily interested in job search assistance (resume review, interview prep, etc.) or are unsure of your career interests/training options, please contact us and ask to schedule an appointment with a career consultant at lcewd-workforceconnections@larimer.org or 970-498-6600.

If you have chosen a certificate/degree for training and a training provider, please complete the following questions to help us determine potential eligibility for training funding and other service referrals. Once your interest form has been reviewed, you will be contacted by a team member, usually by email.

While your response will help us assess and connect you to the services that best match your needs, it does not guarantee eligibility for training funding. We will do our best to connect you to available services to meet your needs.

Please note that we are no longer able to provide scholarship funds for esthetician related credentials, due to a change in our labor market information.

You may contact us at LCEWD-training@larimer.org if you have additional questions or concerns about your training interests.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County of Residence*
Example: Larimer
Phone Number
Please enter the best phone number to reach you at. By providing a telephone number and submitting the form you are consenting to be contacted by SMS text message. Message & data rates may apply. Reply STOP to opt out of further messaging.
Email*
example@example.com
Last 4 Digits of SSN*
xxxx
Date of Birth*

MonthDayYear
1. Are you registered in Connecting Colorado?*

YesNo
You must be registered in Connecting Colorado to process your Training Interest Form. If you have not already, please complete registration at https://www.connectingcolorado.com/
2. How did you learn about potential training funding? Check all that apply.*

LCEWD Staff MemberLCEWD WebsiteFRCC/AIMSAnother training providerWord of mouth/friendCurrent employerColorado National GuardOther
3. Are you registered with Selective Service?*

YesNoN/A
x3. Are you registered with Selective Service?*

YesNoN/A
4. Are you legally able to work in the United States?*

YesNo
x4. Are you legally able to work in the United States?*

YesNo
5. Have you experienced a layoff within the last 5 years?*

YesNo
Please list the employer from which you were laid off. *
Please list the job title. *
How many approximate hours were you working per week?*
Did you receive Unemployment Insurance after your layoff, or have you recently applied for Unemployment Insurance and are waiting for the outcome?*

YesNo
How many weeks did you look for jobs in the same field after your layoff?*
6. Are you currently employed?*

YesNo
Please list your current employer or business name. *
Please list your job title.*
Please list your hourly wage. *
Example: $15/hr
How many approximate hours are you working per week?*
Are you currently self-employed?*

YesNo
Were you laid off from your most recent job?*
How long have you been out of work?*
Were you self-employed?*

YesNo
Have you permanently closed your business?*

YesNo
Are you currently receiving Unemployment Insurance, or have you recently applied for Unemployment Insurance and are waiting for the outcome?*

YesNo
How many weeks have you been requesting UI payments?*
7. Since March 2020, in what ways have you and your household been impacted by the COVID pandemic? Check all that apply. NOTE: "Household" can include those 18 and older who live with you and share expenses, including rent.*

I experienced financial impacts due to COVID from a layoff.I experienced financial impacts due to COVID from reduced hours at work.A member of my household experienced financial impacts due to COVID, including a layoff, reduced hours, or other negative impacts.I experienced a disruption in my own education due to COVID (ex: could not attend classes due to shut down, could not transition to online classes as a student)I experienced an economic loss as a result of the transition to virtual education/services due to COVID (ex: had to purchase equipment and/or materials out of pocket as an educator, counselor, etc. when schools/services were shut down)Neither myself nor my household have been economically impacted by COVID.Other
x8. What was the approximate income of your household for the last month? Please note that this refers to the total income of all in the home (18 and older) who share expenses.
Last month's household income
xWhat is the approximate projected income of your household for the next month? Please note that this refers to the total income of all in the home (18 and older) who share expenses.
Next month's household income
8. What is your approximate income for the upcoming month? This refers to the net income that you will bring in as an individual to your household. *
Individual income
xWhat is the total number of people in your household, including yourself and those under the age of 18?
If you are the only person in your household, please enter "1"
LCEWD operates under Veterans Priority of Service. Please review this webpage to determine if you are an Eligible Veteran or Eligible Spouse of a Veteran:

https://www.larimer.gov/ewd/programs/veterans/veteran-eligibility-requirements
9. Are you a veteran or eligible spouse of a veteran? Please see the above link for more information on veteran eligibility.*

YesNo
10. Are you 25 years of age or older?*

YesNo
11. Have you received your high school equivalency (GED) or high school diploma?*

YesNoIn progress
x11. Have you received your high school equivalency (GED) or high school diploma?*

YesNoIn progress
12. What career, training, or internship interests are you seeking potential funding for?*
13. Please select the statement that best matches your interests. Choose one.*

I am exploring my career options and have not researched training opportunities.I have researched possible training programs and providers but have not registered for training.I have registered for training but not started classes.I have started classes towards a certificate or degree.
14. Which best describes your employment goal after completing training? Choose one.

Obtain full-time employment (40 hours/week)Obtain part-time employment (less than 40 hours/week)Start my own business (self-employment)Avert a layoff at my current place of employmentIncrease wage at my current employmentObtain a promotion at my current employmentOther
15. If you know your school (training provider), please list the institution below. If you have not chosen a school or are exploring careers, please list N/A.*
16. Please list the anticipated or expected start date of your training. *
17. How long will the anticipated training take to complete? Choose one.*

Under 3 months3-6 months6-12 months12-24 months24+ monthsN/A (I have not selected a training provider or career)
x17. How long will the anticipated training take to complete?*

Under 3 months3-6 months6-12 months12-24 months24+ monthsN/A (I have not selected a training provider or career)
18. Have you worked with any of the following programs over the last 6 months? Check all that apply.*

SNAP (Food assistance)TANF (Temporary Assistance for Needy Families)LEAP (Low-income Energy Assistance Program)CCAP (Child Care Assistance Program)SSI (Supplemental Security Income)MedicaidMedicare Part DSection 8 HousingHousing AuthorityHomeless shelter (experiencing homelessness)Refugee Cash AssistancePSS (Project Self Sufficiency)DVR (Department of Vocational Rehabilitation)Legal (justice-involved)WIC (Special Supplemental Nutrition Program for Women, Infants, and Children)Free and Reduced Lunch (NSLP) and/or School Breakfast Program (SBP)Head Start and/or Early Head StartCHIP (Children’s Health Insurance Program)Awarded a PELL grant through FAFSARegistered apprenticeship programsNone of the above
19. Do you identify with any of the following groups? Check all that apply.*

Displaced homemakerNative American, Alaska Native, and/or Native HawaiianAn individual with a disabilityAn older adult (age 55 and older)An individual who faces a substantial cultural barrierAn ex-offenderEligible Migrant and/or Seasonal Farm WorkerAn individual within two years of exhausting lifetime TANF eligibilitySingle parent (includes single pregnant women)New American (individuals who arrived in the U.S. as immigrants or their children)Individual unemployed for at least 12 of the past 26 weeks (The 12 weeks without a job do not need to be consecutive)Long-term unemployed individual (27 or more consecutive weeks being unemployed)None of the above
If you would like assistance with your training application, or would like to discuss accomodations, you may contact LCEWD's Disability Program Navigator:

Blake Dowling

bdowling@larimer.org

970-498-6041
20. I'm also interested in: Check all that apply.*

Career exploration and planningJob search supportPaid work experience (internship)None of theseOther
21. Please select the statement that best matches your employment and training needs. Choose one.*

I prefer to work on my own to achieve my goals and do not need staff assistance.I prefer to have guidance from a staff member to get started on my goals and then prefer to work on my own.I prefer to have guidance and support from a staff member more intensively throughout the journey toward my goals.
x21. Please select the statement that best matches your employment and training needs. Check one.*

I prefer to work on my own to achieve my goals and do not need staff assistance.I prefer to have guidance from a staff member to get started on my goals and then prefer to work on my own.I prefer to have guidance and support from a staff member more intensively throughout the journey toward my goals.
22. Please list any personal or professional responsibilities that may interfere with your training success and completion. Please leave blank if not applicable.
Verification of Application Information

I certify that the information contained in this application is true to the best of my knowledge. I am aware that this information is subject to review and verification and that I may be required to provide documentation in its support.

I am also aware that I am subject to immediate exit from the program if I am found ineligible after enrollment and may be prosecuted for fraud and/or perjury if the information I have provided is false. I authorize the release of information contained in this application for use in verifying my eligibility for Larimer County Economic and Workforce Development (LCEWD) programs; however, I understand that the information will not be released for other purposes.
Customer Electronic Signature for Verification of Application Information*
Electronic Signature: First and Last Name
xSignature

Clear
Should be Empty:

Economic and Workforce Development is committed to providing accessibility for everyone. If you need assistance completing this form, reach out to Blake Dowling at lcewd-ada@larimer.org or via phone at 970.498.6041.

LCEWD Training Interest Form

Verification of Application Information