Prospective Fellow Inquiry Form

Prospective Fellow Inquiry Form

Village Collective Inc is currently accepting male Fellows between the ages of 18-24 years of age who are currently enrolled or plan to enroll in a workforce credential, associate’s degree or certificate program of study.
Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Mobile Number
Gender*

MaleFemaleOther
Do you have a high school diploma or GED?*
School or Program where you received your High School diploma or GED certificate
Do you prefer morning (8am-11:30am), afternoon (noon-4pm) or evening (5pm-7pm) for a phone call?
Have you ever been convicted of a crime?*
How did you hear about the program?
Date*

MonthDayYear
Date
Should be Empty: