Park Heights Culinary Pathways – Participant Intake & Services Interest

  • Park Heights Culinary Pathways – Participant Intake & Services Interest

    Please complete this form to help us understand your interests, needs, and eligibility for Park Heights Culinary Pathways. Your information will help Kanisa La Watu, YES at LHCBRC, Late Bloom, and Better Way of Life Financial coordinate support, training, and resources. By submitting, you consent to the collection and sharing of information as described below.

  • Basic Information

    Tell us about yourself.
  • Format: (000) 000-0000.
  • Date of Birth
     - -

  • Event & Referral

    How did you hear about us?
  • How did you hear about Park Heights Culinary Pathways?*

  • Interests

    Let us know your areas of interest.
  • Which of the following are you interested in? (Select all that apply)*

  • ServSafe & Culinary Details

    Tell us about your experience and certifications.
  • Do you currently have a ServSafe Certification?
  • If yes, when does it expire?
     - -
  • Do you have previous culinary training or experience?

  • Support & Case Management

    Share your support needs.
  • What support services are you interested in? (Select all that apply)*

  • Logistics, Business & Financial

    Help us understand your logistical and financial needs.
  • Do you need assistance with any of the following business services? (Select all that apply)*

  • Scheduling & Access

    Tell us about your availability and access needs.
  • Do you have reliable access to the internet?*
  • Do you have access to a computer or smartphone?*

  • Consent

    Your consent is required to participate and for us to contact you.
  • Information Sharing Preferences: May we share your information with partners for service coordination?*
  • Date*
     - -
  • Should be Empty: