Workforce Job Training Pre Assessment Form
Applicant Name
*
First Name
Last Name
Parent/ Guardian Name (If Applicaible)
First Name
Last Name
Applicant Age
*
E-mail
*
example@example.com
Phone
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Applicant interest program choice:
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Nailtorious Iconz Beauty Academy Licensee Course
Nailtorious Iconz Beauty Academy Refresher Course
Other
When are you seeking to start class or enroll?
*
ASAP
Next Class Start Date
Not Sure
How did you find out about this program?
*
Nailtorious Iconz Social Media
Nurturing Angels Social Media
Referral
Other
If referred by someone, please list name or social media handle below:
Does Applicant have any of the following: (CHECK ALL THAT APPLY)
*
Aggression (Arguing, forcing submission, bullying, fighting, stealing))
Anxiety (Acting in fearful manner, excessive worrying, overwhelmed, inability to cope with daily functioning)
Depression (Overall sadness, low/restrictive activity levels, crying spells, poor appetite)
Withdrawn Behavior (Often alone, non-participation, unresponsive to social initiations)
Has had an IEP/ 504 plan
Other
I attest, all information above is valid and true to the best of my knowledge. Sign below:
*
After you submit this form, your information will be reviewed. If you meet the initial qualifications based on your responses, your information will be forwarded to a partner representative, who will contact you to schedule an assessment. Please note that this is not a scholarship application. Details regarding tuition assistance, funding options, payment plans, and academy programs will be discussed during your scheduled tour. If you have any questions, please contact the Academy Director, Ms. Shaura, at 216-319-5095.
*
Yes
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