What program are you enrolled in?
*
Please Select
Certified Nursing Assistant (CNA)
CLS/Phlebotomy
Emergency Medical Technician (EMT)
Advanced Emergency Medical Technician (AEMT)
Fire Academy
Sterile Processing Technician
Dispatch
Military-connected (veteran, active-duty, or individual with ROTC background)
Name:
*
First Name
Last Name
NSHE ID (Student ID Number):
*
Date of Birth:
*
-
-
Email Address:
*
example@mail.tmcc.edu
Phone Number:
*
Please enter a valid phone number.
Format: 000-000-0000.
Home Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Citizenship Status:
*
U.S. Citizen
Permanent Resident
Other
Highest Level of Education Completed:
*
Less than High School Diploma
High School Diploma
GED
Associate Degree
Bachelor's Degree
Graduate Degree
Other
Degrees and/or Certifications Earned:
Enter degree/certification name(s) and year(s) earned.
Current Work Situation:
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Unemployed
Temporary Worker
Part-Time Worker
Full-Time Worker
Other
Part-Time Average Hours/Week:
Other Work Situation:
*
Employer:
Position:
Length of Employment:
Current Average Hourly Wage (not including overtime):
How will you use this program?
*
Improve Skills in Current Job
Seek Job Promotion
Change Careers
Other
Upload Copy of Resume:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
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Upload Copy of Resume Status:
Are you a veteran?
*
Yes
No
Do you have a documented disability?
*
Yes
No
Is your first language English?
*
Yes
No
Other First Language:
*
Are you a first generation college student?
*
Yes
No
What other circumstances may be relevant to your situation?
Single parent who has custody of my child(ren) at least 51% of the time
Displaced homemaker (unemployed or underemployed) AND have been dependent on someone else AND that support is no longer going to be available to me
Currently on parole or probation, a resident of NNTH, or have been referred by a justice agency (e.g. NDOC, WCSO)
Pregnant woman
VA Disability
Are you currently receiving public assistance?
SNAP (FKA Food Stamps)
TANIF (Cash Assistance)
Other
Other Public Assistance:
*
Are you caring for aging parent(s) or someone with a disability?
*
Yes
No
Are you paying out-of-pocket for childcare?
*
Yes
No
Are you financially impacted by any of these?
Medical Condition
Mental Health Challenges
Substantial Debt
Legal Challenges
Are there other financial impacts we should consider?
Would you be interested in receiving more referrals/resources that may provide support to your current situation(s)?
*
Yes
No
Certification and Acknowledgment
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Please verify that you are human:
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