ULCC Program Application Form

Workforce Development Training Program Application Form
Date

MonthDayYear
Date
Program Applying For*
Referral Type*
If Other referral type, please provide name
Name*

First NameLast Name
Gender*
Date of Birth*

MonthDayYear
Race/Ethnicity *
Are you a US Citizen?*

YesNo
Email*
example@example.com
Cell Phone Number*
Please enter a valid phone number.
Please note that all applicants must be residents of Mecklenburg County.

If your photo ID or driver’s license does not list a Mecklenburg County address, you will need to provide an additional form of proof of residency. Acceptable documents include a utility bill or official mail that includes your name and a current Mecklenburg County address.

Thank you for your understanding.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Personal Data

eDUCATIONAL BACKGROUND
Do you have a copy of your high school diploma or GED certificate? If so, please upload.

YesNo
File Upload

Cancelof
Have you attended college?
If yes, name of college:
List any certifications or specialized degrees:
List any military experience:

How did you hear about the Urban League of Central Carolinas?*

RadioWebsiteSocial MediaFriendWalk InPartner AgencyOther
Please list the name of the publication, platform or agency:

I certify that the information I have provided above are true to the best of my knowledge without any malice or any intention to commit acts of misrepresentation.

I am aware that any false, misleading, or deceptive information provided may lead to withdrawal, expulsion, or any disciplinary action which may be dealt with by the school's authorities.
Applicant's Signature*

Clear
Date Signed by Applicant*

MonthDayYear
Date
Should be Empty: