Arviiq Training Registration Form

APPLICANT INFORMATION

Please make sure all applicable fields are completed. Failure to fill out all applicable fields will be considered an incomplete application.
Full Name:

First NameLast Name
Other Names Used:
Date of Birth:

MonthDayYear
Date
Mailing Address

Mailing Address or P.O. Box

Address Line 2

CityState / Province

Postal / Zip Code
Physical Address:
Please do not list a P.O. Box. If you do not have a legal physical address, please include a description of your residence.
Primary Phone Number (Please do not list a work phone number):
Phone Number(s) (to Receive Messages when we cannot reach you on your phone):
Can we leave/send you messages? Select all that apply.

VoicemailText MessagesDo not leave/send me messages
E-mail:
example@example.com
Identification Number:
Type of Identification:

Alaska State IDAlaska Drivers LicenseOther
Gender

MaleFemale
Marital Status

SingleMarriedDivorcedSeparated
Did you enrolled in a Federally Recognized Tribe?

YesNo
If yes, please provide your Tribe's name and enrollment number:
Please indicate the program/training you are applying for:
If you selected Cultural Learning Class, please specify which class you're taking:
EDUCATIONAL BACKGROUND
Did you graduate from high school?

YesNo
If yes, please provide school name and year graduated:
Did you earn your GED?

YesNo
If yes, please provide GED completion date:
Other Education (College, Vocational, Certifications):
Please include institution(s), degrees or certificates earned, and the year(s) of completion.
WORK EXPERIENCE (IF APPLICABLE)

Please provide details about any relevant work experience. Attach additional sheets if necessary.
Company/Employer Name:
Job Title:
Dates of Employment:
Job Duties/Responsibilities:
Please include
Copy of your most recent pay stub (if working):

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PROOF OF ELIGIBILITY
Please attach the following documents:
- Copy of High School Diploma or GED (if applicable)
- Copy of State and/or Tribal Identification
- Most Recent Pay Stub (if applicable)
- For men aged 18-25: Proof of Military Selective Service Registration
  (Available at https://www.sss.gov/verify/ )
Note: Failure to submit the required documents may result in delayed processing or rejection of your application. You may also submit this via email to training@kuskokwim.com or in person at the Arviiq Center.
File Upload

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STATEMENT OF INTENT
In 2-3 sentences, please describe why you want to participate in this training program and how it aligns with your personal or career goals:
HEALTH & SAFETY INFORMATION
Do you have any medical conditions or disabilities that might require accommodation during the training program?

YesNo
If yes, please explain:
Note: Please contact the Arviiq Center if you require and special accommodations.
EMERGENCY CONTACTS
Emergency Contact 1
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Relationship to Participant:
Emergency Contact 2
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Relationship to Participant:
ACKNOWLEDGMENT & CONSENT
Please read and acknowledge the following by signing below.
- I acknowledge that I have read and understand the eligibility requirements and application process for the program(s) I am applying for.
- I confirm that all information provided in this application is true and accurate to the best of my knowledge.
- I consent to Arviiq conducting a background check as part of the application process, as outlined in the applicant policies and procedures.
- I understand that acceptance into the program is not guaranteed, and that Arviiq may review my qualifications based on the application submission, my eligibility, and other factors.
- I agree to adhere to the rules, regulations, and policies of the Arviiq Regional Economic Development & Training Center if accepted into the program.
- I consent to Arviiq sharing my personal information with relevant funding bodies and partnering organizations to facilitate my training, as necessary.
Printed Name:

First NameLast Name
Signature

Clear
CONSENT FOR MINORS (IF APPLICABLE)
Parent/Legal Guardian Name:

First NameLast Name
Relationship to Participant:
Signature

Clear
LIABILITY WAIVER
By signing below, I acknowledge and agree to the following:
1. I understand that participation in the training program involves inherent risks, including but not limited to physical injury, and I assume all risks associated with my participation.
2. I agree to release, discharge, and hold harmless the training facility, its employees, agents, and instructors from all claims, liabilities, or damages arising out of my participation in the training program.
3. I understand that it is my responsibility to consult with a physician prior to participating in the training program if I have any concerns about my health or physical condition.
4. I agree to abide by all rules and guidelines set forth by the training facility and its staff.
Printed Name:

First NameLast Name
Signature:

Clear
PHOTO RELEASE
By signing below, I grant permission for the training facility to use my photograph or video footage for promotional purposes, including but not limited to social media, websites, and marketing materials.
1. I understand that my image may be used in various forms of media and will be owned by the training facility.
2. I agree that I will not receive any compensation for the use of my image.
3. I release the training facility from any claims or liabilities related to the use of my photograph or video footage.
Printed Name:

First NameLast Name
Signature

Clear
For questions, more information or to request assistance with your application, contact us at training@kuskokwim.com or (907) 675-4275.
Form last updated 04/09/2025.
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APPLICANT INFORMATION

EDUCATIONAL BACKGROUND

WORK EXPERIENCE (IF APPLICABLE)

PROOF OF ELIGIBILITY

STATEMENT OF INTENT

HEALTH & SAFETY INFORMATION

EMERGENCY CONTACTS

Emergency Contact 1

Emergency Contact 2

ACKNOWLEDGMENT & CONSENT

CONSENT FOR MINORS (IF APPLICABLE)

LIABILITY WAIVER

PHOTO RELEASE