TWC/WI0A CLASS INFORMATION & BID LETTER REQUEST
Today's Date
*
-
Month
-
Day
Year
Date
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Social Security Number
*
VALID SSN
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Gender
*
Male
Female
A gender that is not singularly 'Female' or 'Male'
Transgender Male to Female
Transgender Female to Male
Refused/ Don't Know
Other
Disability
*
Yes
No
Are you a veteran?
*
Yes
No
VETERANS ONLY: Do you have a DD214 form?
*
Yes
No
VETERANS ONLY: Please upload form DD214
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of
Education
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9th
10th
11th
12th
High School
GED
12th+ (post Secondary)
Some College
Associate Degree
Bachelor's Degree
Master's Degree
Minor (doesn't go to school)
Race
*
American Indian/ Alaskan Native/ or indigenous
Asian/ Asian American
Black/ African American/ or African
Native Hawaiian/ or Pacific Islander
White
White/ African American
White/ American Indian
White/ Asian
White/ Pacific Islander
African American/ Asian
African American/ American Indian
African American/ Pacific Islander
Asian/ American Indian
Asian/ Pacific Islander
American Indian/ Pacific Islander
Multiple
Ethnicity
*
Non-Hispanic/Non-Latino
Hispanic/Latino
Ethnicity Unknown
Income
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$0-$20,999
$21,000-$27,999
$28,000-$32,999
$33,000-$38,999
$39,000-$45,999
$46,000-$49,999
$50,000-$55,999
$56,000 or more
Current living situation
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Own
Rent
Living w/ others
Transitional/ Temporary Housing
Homeless
Other
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Course Desired
*
Desired Start Date
*
TWC/WIOA Referral
Yes
No
TWC/WIOA Referral
*
Yes
No
Case Worker's Name
*
First Name
Last Name
Case Worker's Email
*
example@example.com
Case Worker's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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