GoodTech Academy Participant Interest Form

Goodwill Industries of East Texas

GoodTech Academy Participant Interest Form
Participant Information

Please enter your information for us to confirm eligibility and best ways to contact you.
Name*

First NameLast Name
Today's Date*

MonthDayYear
Email Address*
example@example.com
Home Phone Number
Format: (000) 000-0000.
Cell Phone*
Format: (000) 000-0000.
Are you at least 18 years of age?*

YesNo
Do you have at least a High School Diploma or GED?*

YesNo
If no, are you working to get your GED/Diploma?

YesNo
How did you hear about the program?
Please provide as much information as you are willing to share
Participant Course Interest

Please select only the courses you are interested in
Beginner Courses

Basic Computer LiteracyInternet and SafetyEmailMicrosoft Office Products: Word, PowerPoint, ExcelSkills to Succeed Academy
Intermediate and Advanced Courses

CompTIA IT FundamentalsCompTIA A+CompTIA Network+CompTIA Security+CompTIA Cybersecurity Analyst+Other course not listed
Participant Class Preferences

Please provide your preference on classes and your earliest start date. If you do not have a preference, you may leave these blank.
Earliest start date

MonthDayYear
This is the earliest YOU can begin classes. We cannot guarantee it will start then.
Attendance options

VirtualSelf-paced coursesIn-person courses
If preferences are in person, please answer the following two questions
Times preferred

Mornings (9am-12pm)Days (1pm-4pm)Nights (after 5pm)No Preference
Days preferred

Mondays and WednesdaysTuesdays and ThursdaysSelf-paced coursesNo Preference
Note: These are strictly preferences. We cannot guarantee those times and days are currently running though we will do our best to accomodate.
Please sign here to confirm you read the above statement
Additional Services needed

If you need any additional services with us or are interested in our services, please provide those here.
Please select any interest in the following

Job Placement AssistanceJob Readiness ClassesGoodAssistS2S Academy (Skills to Succeed)Adult Education Classes (GED Prep)Professional CounselingOther (Please Specify)
Details regarding any accommodations or relevant information/preferences needed for success in the program
Should be Empty:

Goodwill Industries of East Texas

Participant Information

Participant Course Interest

Participant Class Preferences

Additional Services needed