LCEWD Training Interest Form

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

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

If you are primarily interested in a job search 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 estheticians or supporting certificates due to a change in our labor market information.

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

Please contact us at 970-498-6600 or lcewd-workforceconnections@larimer.org if you have additional questions or concerns.
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.
Email*
example@example.com
Last 4 Digits of SSN*
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.*
Are you currently self-employed?*

YesNo
How many approximate hours are you working per week?*
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)Other
8. What was your approximate household income for the last month? Please note that this refers to the total income of all in the home (18 and older) who share expenses. *
What is your approximate projected household income for the next month? Please note that this refers to the total income of all in the home (18 and older) who share expenses.*
What is the total number of people in your household, including those under the age of 18?*
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 above for more information.*

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)Housing AuthorityPSS (Project Self Sufficiency)DVR (Department of Vocational Rehabilitation)Legal (justice-involved)Registered apprenticeship programsAwarded a PELL grant through FAFSAHomeless shelter (experiencing homelessness)None 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
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.
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.
Signature*

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