Community Member Interest Assessment

This form is NOT for District 1199C union members!
1199C members should please use this form instead: https://1199ctraining.org/MemberIntake

Contact Information

Name*
Are you currently employed?
We will use your response to determine which FREE program(s) you might be eligible for.
What is your birthdate?

Employment

Work Status

Program Interest

Please indicate which program(s) you are interested in.
Please note, all students must complete an academic assessment before starting any Training Fund class.

Nursing & Direct Care Programs
Human Services Programs
Other Training Programs
Academic Programs
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