38126 Technology Hub Interest Form

38126 Technology Hub Interest Form

38126 Technology Hub Interest Form

All fields marked with * are REQUIRED
Name*

First NameLast Name
Email*
example@example.com
Email Address*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth (Month, Day, Year)*

MonthDayYear
Date
Age Ranges:*
What is your specific age?*
Gender*

MaleFemaleNon-BinaryTransgenderOtherPrefer Not to Answer
Sexual Orientation*
Pronouns: (His, Her, Them)*
Race/Ethnicity*

African American/BlackWhiteHispanics AmericanAsian AmericanPacific/IslanderOther
High School Graduation Year*
Do you have experience in Cybersecurity?*

YesNo
Are you currently employed?*

YesNo
Are you employed?*
Do you have access to the internet?*

YesNo
Are you a traditional or virtual learner?*
Are you willing to commit a minimum of 20 hours a week to completing the cybersecurity certification course?*

YesNo
Can you pass a background check?

YesNo
Are you interested in learning more about the Cybersecurity program?*

YesNo
Why are you interested in cybersecurity?
Why should you be selected for this program?
What are your goals, upon completion of this program? What skills and takeaways do you hope to gain from this program?
What do you do, for work? What is your, current, work schedule like?
What are some of the challenges you face, that may make this process more difficult? (Financial issues: mortgage, food instability, etc., Health concerns, Any known pending obligations)
What motivates you?
How do you deal with pressure or stressful situations?
When you’re balancing multiple projects, how do you keep yourself organized?
Can you describe your educational background, to include the highest level of education you have received (high school, trade school, higher education)?
What did you do, in the last year, to improve your knowledge?
How do you prioritize work?
How do you define success? How would you define success, after completing the program?
Do you have leadership experience?
What is your preferred style of work (independently/self-starter or on a team)?Describe what that means to you.
Emergency Contact Info
Emergency Contact Name:*

First NameLast Name
Emergency Contact Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Email:*
example@example.com
By submitting this form, I agree that 38126 Technology HUB may call/text me, manually and/or by automated dialing system, at the telephone number or numbers I provided about educational products or services or about other products or services in which 38126 Technology HUB believes I may be interested. I understand that I am not required to consent or otherwise provide to 38126 Technology HUB my contact information or agree to be contacted as a condition of purchasing or receiving any products or services from 38126 Technology HUB.
Name*

First NameLast Name
Gender*

MaleFemale
Should be Empty: