Name *

First Name

Last Name

Phone

(###)

###

####

Would you like to participate in a free training program that will teach you a skill and help you find employment and/or a career?

Yes

No

Highest Level of Education * *

Sixth Grade

GED/High School Diploma

Some College

Trade Apprenticeship

College Degree

Have you ever been justice-impacted? * *

Yes

No

What is your preferred method of contact? (Please note that we will be following up with you via your preferred method of contact within one week) *

Email

Phone Call

Text Message

Where did you learn about the 10,000 Jobs Campaign Training and Employment Program? *

Email

Odunde Festival 2024

Juneteenth Celebration

Other