CG Charitable Services Program Application

CG Charitable Services Program Application

Complete the attached form to get contacted and enrolled in a learning cohort.
Full Name

First NameLast Name
Contact & Preferences
Date of Birth (optional)

MonthDayYear
County
ZIP Code
Preferred Contact Method
Preferred Language
Program Interests & Career Goals
Highest Education Level Completed
Are you currently enrolled in school?
Certifications, licenses, or relevant training
Days and times you are generally available for training
Preferred Training Modality
Workforce Pre-Screen
Hours Worked per Week (if currently employed)
Approximate Household Size
Approximate Household Income Range (optional)
Income Period (optional)
Do you receive Unemployment Insurance benefits?
Have you been laid off or otherwise dislocated from a job?
Are you a veteran or an eligible spouse of a veteran?
Do you participate in public assistance programs?
Are you age 16–24?
If age 16–24, are you currently attending school?
Have you had justice-system involvement that you would like considered for referral or support? (Optional)
Are you legally authorized to work in the United States?
Optional TWC Vocational Rehabilitation Referral Screen
Does a disability-related condition create a barrier to preparing for, obtaining, retaining, or advancing in employment? No diagnosis is requested; answering is optional.
Do you already have a TWC Vocational Rehabilitation counselor?
Do you consent to sharing counselor contact details for referral follow-up?
TWC VR Counselor Name (only if you answered yes and consent to sharing)
TWC VR Counselor Contact Information (only if you answered yes and consent to sharing)
Prior Services, Referrals & Funding
Are you currently or have you previously been enrolled with any of these services?
Workforce Solutions, WIOA, TWC VR counselor, or case manager name/contact (optional)
Has training funding or a purchase order already been approved?
Purchase Order Number (only if approved; optional)
Barriers & Support Needs
Which supports would help you participate in training? (Select all that apply)

Other
Optional confidential follow-up about support needs or accessibility accommodations
Program Commitments & Expectations
I understand that attendance, certification, uniform, or hiring-event requirements will be explained for my selected training track and apply only where relevant.
I understand that CG Charitable Services cannot determine program eligibility or promise funding, and sponsored training cannot begin without written authorization or a purchase order.
Privacy notice: Information is collected to support application review, referral, and eligibility screening. Sensitive questions are voluntary; you may choose “Prefer not to answer.” CG Charitable Services cannot determine eligibility or guarantee funding. Sponsored training cannot begin without written authorization or a purchase order.
May CG Charitable Services contact you about your application and referrals?
OPTIONAL: Do you authorize CG Charitable Services to share the minimum necessary application information with TWC/Workforce Solutions or your referring agency for referral and eligibility screening?
Staff Review (Internal)
Potential Funding Pathway
Referral Status
Staff-Recorded Counselor / Case Manager
Eligibility Verification Pending
Authorization / Purchase Order Received
Training Start Clearance
Referral Agency (if applicable)
Enter "N/A" if wasn't referred
Which CG Charitable Services Program(s) do you want to enroll in? Check all that apply.
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Current Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Are you 18 years or older?
Current Employment Status
Do you have reliable transportation to travel to training facilities?
Can you commit to being present and on-time for training events? Event start and end time varies.
Are you legally eligible to work in the United States
Describe your career goals and the training or support you are seeking.

CG Charitable Services Program Application

Contact & Preferences

Program Interests & Career Goals

Workforce Pre-Screen

Optional TWC Vocational Rehabilitation Referral Screen

Prior Services, Referrals & Funding

Barriers & Support Needs

Program Commitments & Expectations

Staff Review (Internal)

Program Commitments & Expectations