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Getting To Know You!
Please read and answer the questions below, this will help us know how best we can serve you!
Email *
The START PROGRAM SERVES CLIENTS AGES 25 and Up!
What is your first and Last Name? *
Date of Birth *
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DD
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Please provide your home address *
What is the best number to reach you at? *
Phone number *
Do have access to the internet *
How did you hear about the program? *
What technology devices do you have available to you? *
Required
We have provided a list of program services below; please let us know what services you are interested in receiving. *
Are you willing to engage in online classes and workshops at least 2 days out of the week? *
What career/s are you interested in ? (Please Check All that apply) *
Required
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