WorkFORCE Connections Interest Form - United Way of East Central Alabama

Let's Get to Know You:
Name:*
First Middle Last Suffix
Home Address:*
Street Address City State ZIP Code
Birthdate*
Email Address:*
Phone:*
Tell Us About Yourself:*
Please check the box that applies to you.
- I am currently enrolled in school and between the ages of 16 - 21
- I am currently NOT enrolled in school and between the ages 16 - 24
I have had or am currently experiencing the following life experiences:*
Please check all that apply to you. *The following life experiences will not ensure or deny you access to the WorkFORCE Connections program*
- In need of a High School Diploma or GED
- Having difficulty with math and/or reading
- Juggling the responsibility of a child
- Searching for a stable place to live
- Want to earn a credential or college degree
Why are you interested in WorkFORCE Connections?

Let's Get to Know You: