Caminos LIT information form
Please fill in the required information and our Caminos Specialist will contact you within. Fall Cohort starts September, 11th.
This program is only for US Residents.
*Answering all questions is required.
Full name
*
First Name
Last Name
Today's date
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
How did you find out about the program?
*
Please Select
Facebook
LinkedIn
Instagram
La Movida Radio
Flyers
Word of Mouth
Family/friend referral
Centro's Website
Referred by another organization
Other
What is your age?
Which city do you live in?
*
Which county do you live in?
What is your race/ethnicity?
*
Please Select
Black/African American
American Indian and Alaskan Native (Cherokee, Chippewa, Navajo, Sioux)
Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Hmong, Other Asian)
Native Hawaiian and other Pacific Islander (Guamanian, Chamarrow, Saamoan)
Two or more races
Hispanic/Latino (Mexican, Puerto Rican, Cuban and other Hispanic or Latino)
White, non Hispanic or Latino
From the following list, please check the items that apply to you:
*
Completed High School or GED/HSED Diploma
Completed High School in the country of origin (must have access to original documents)
18 years or older
Authorized to legally work in the United States
English Language Learner at an Intermediate or Advanced Level
Please indicate your English Level
*
Beginner
Intermediate
Advanced
Please indicate the best time to call you:
*
I understand that I will be contacted within 7-14 days when training is happening, otherwise within 1-3 days.
*
Yes
Submit
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