Name (required)
 
Previous Name
 
Address (required)
 
 
 
 
Gender
Male
Female
 
U.S. Citizen (required)
Yes
No
 

If you are not a U.S. citizen, we require a copy of your green card.

Highest Academic Level Attained
High School Dimploma
Some High School
High School Certificate of Completion
GED
Bachelor Degree
Graduate Degree
Associate Degree
Some College
 
Reason for Taking the Welding Class
Prepare to seek employment in welding
Prepare to make a career change
Improve current job skills
Required by employer
Personal or self improvement
 
 
 
Are you currently renrolled in any other training program? (required)
Yes
No
 
Have you ever been convicted of a felony? (required)
Yes
No
 
Emergency Contact (required)
 
 
 
 
Agreement (required)
Yes
No
 

I give permission for SCILL to share this information with other agencies who provide assitance with job training and education.