Work in Burke Information Request Form

Work in Burke Information Request Form

Interested in learning more about a specific Workforce Development Program housed within the Industrial Commons? Send us an interest form and we will put you in contact with someone who can answer your questions!
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Phone Number*
Please include your area code. Format: (000) 000-0000.
Age*
What is your date of birth?

MonthDayYear
Month-Date-Year
Are you currently in school?

Yes, in High SchoolYes, at Burke Middle CollegeYes, in Community CollegeYes, at a 4-year college or universityNoOther
Check all boxes that apply to you*

Currently unemployedNot enrolled in post-secondary educationCurrently underemployed (working less than 30 hours a week)Looking for a new career opportunityLooking to gain a new skillLooking for assistance with overcoming barriers to employmentLooking for professional development assistanceLooking for connections to support servicesLooking for assistance with completing a High School diploma or GED program
Program of Interest (select all that apply)*

OPT-IN (Opportunity Internship)J.E.T. (Jobs, Education, Training)J.E.T.'s Per Scholas IT Pathway (I.T. Training Program)ISP (Industrial Sewing Program)Other career or educational assistance
Will you be 18 years old before June 18, 2025?

YesNo
Is there another reason you would like to connect? (Skip if none)
How did you hear about this opportunity?*

Instagram AdsFacebook AdsIn-person eventLinkedINFrom a friend, parent, or by word of mouthPosters / FlyersPiece of Mail I receivedOther
If you selected "Other", please specify
Should be Empty: