Core Scholars Interest Form
Please complete this interest form to share your contact information, background, training interests, availability, and consent for follow-up regarding Core Scholars programs.
Contact Information
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Mobile Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Method of Contact
*
Phone Call
Text Message
Email
Street Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
City
*
County
*
ZIP Code
*
Demographics and Background
What is your age range?
*
Under 18
18–20
21–24
25–30
31 or Older
What is your current employment status?
*
Employed Full-Time
Employed Part-Time
Self-Employed
Unemployed
Student
Other
What is the highest level of education you have completed?
*
Please Select
Less Than High School
High School Diploma
GED
Some College
Technical or Trade Certificate
Associate Degree
Bachelor’s Degree
Master’s Degree
Doctorate or Professional Degree
Transportation and Program Interest
Do you have reliable transportation to attend training?
*
Yes
No
Sometimes
I May Need Transportation Assistance
Which Core Scholars program are you interested in?
*
Basic Plumbing Trades Training
Blueprint Reading and Construction Plan Reading
Both Programs
What is your current level of plumbing experience?
*
No Experience
Beginner
Some Hands-On Experience
Currently Working in the Trade
Previously Worked in the Trade
What is your current level of blueprint-reading experience?
*
No Experience
Beginner
Some Experience
Comfortable Reading Basic Plans
Experienced
Which additional skilled-trade classes would interest you in the future?
Basic Electrical
Carpentry
Painting and Drywall
Flooring Installation
HVAC
Welding
Masonry
Roofing
General Construction
Other
Goals, Availability, and Follow-Up
Why are you interested in skilled-trades training?
*
Start a New Career
Increase My Income
Gain a Marketable Skill
Improve My Current Skills
Start My Own Business
Support My Family
Explore a New Interest
Build Confidence in My Abilities
Other
Please briefly describe what you hope to accomplish through this training.
*
Are you currently seeking employment in the construction or skilled-trades industry?
*
Yes
No
I Am Already Employed in the Industry
I Plan to Seek Employment After Training
Would you be interested in job-placement or apprenticeship assistance after completing training?
*
Yes
No
Maybe
I Need More Information
Which days are you generally available for training?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Which training times work best for you?
*
Weekday Mornings
Weekday Afternoons
Weekday Evenings
Saturday Mornings
Saturday Afternoons
Sunday Afternoons
Flexible / Varies
How soon would you like to begin training?
*
As Soon as Possible
Within 30 Days
Within 60 Days
Within 90 Days
Within Six Months
I’m Not Sure
Can you commit to attending all scheduled classes and hands-on training sessions?
*
Yes
No
Maybe
Depending on the Schedule
Would you be willing to pay for training?
Please Select
YES
NO
This is a fill in the
blanks
field. Please add appropriate
blank
fields and text.
How much could you afford for training?
Referral, Communications, and Consent
How did you hear about Core Scholars?
*
Please Select
Facebook
Instagram
Northeast Georgia Black Chamber of Commerce Website
Email
Flyer or Poster
Friend or Family Member
Community Organization
School or College
Job Fair or Event
Other
Referrer Name
Would you like to receive information about upcoming Core Scholars classes, scholarships, workshops, and application dates?
*
Yes
No
Communication Consent
*
I authorize the Northeast Georgia Black Chamber of Commerce and the Core Scholars Program to contact me by telephone, text message, and email regarding training opportunities, applications, schedules, scholarships, employment resources, and related programs
Interest Form Acknowledgment
*
I understand that submitting this interest form does not guarantee admission, enrollment, scholarship funding, employment, certification, or placement in a Core Scholars training program. I understand that I may be required to complete a separate application and eligibility process
Electronic Signature
*
Submit
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