Computer User Support A+ ONLY Training Program Application (Track #2) Cohort 4
Welcome and congratulations on taking your first step towards your career in the Information Technology field!

The Computer User Support A+ ONLY Training Program is a unique coaching and training program that includes CompTIA A+ Certification Exam Prep, Financial Coaching, and Employment Coaching. Learn more here:

To apply, please fill out the following application completely. This is a two part Application.

Part 1: Center for Changing Lives Program Application below
Online Application DUE BY September 10, 2017.

Part 2: Email and/or call Kayla Villalobos at or (773) 342-6210 Ext: 251 to confirm a time and day for you to complete your pre-assessment and interview day.

After you have completed BOTH the Online Application and the Assessment and Interview Day at Center for Changing Lives you will be contacted for next steps!

Please email with any questions or give her a call at (773) 342-6210 EXT 251.

Email address *
Part 1a: General Information
Your Full Name: *
Your answer
Date of Birth: Month/date/ year *
Your answer
What is your mailing address? *
Your answer
Do you have an email address? If yes, please type it in the box below. If no, please write "N/A" *
Your answer
What is the best telephone number at which to reach you? *
Your answer
How did you hear about CCL's Computer User Support A+ ONLY Training Program ? *
Please provide more details here. *
If you answered "Friends or family" please tell us who. If you answered "Case Manager", please tell us who and from where. If you answered "flyer," please tell us where you saw the flyer. If you answered "resource or community center" please tell us which one. For other, please specify.
Your answer
What is the highest level of education that you have completed? *
Are you eligible to work in the United States? *
Are you able to commit to an 18 week program? *
Are you currently employed? *
If you are employed, what is your current work schedule? Please outline days and hours. If you are not employed, type "N/A" *
Your answer
Can this schedule be flexible to accommodate the program schedule? *
Your answer
If you are not employed, are you seeking employment to sustain yourself throughout the next 18 weeks? If you are employed, type "N/A" *
Your answer
Part 1b. Program Interest:
In this section, we would like to learn more about your interest in this program, your expectations, and what goals you hope to achieve.
What are your expectations surrounding this Computer User Support A+ ONLY Training Program and your participation in it? *
Your answer
What do you see yourself doing once you have your CompTIA A+ Certification? How will this enhance your life overall? *
Your answer
What are some of your Financial Goals that you see yourself working towards during this program with the IT Financial Coach? *
Your answer
What are some of your Employment Goals that you see yourself working towards during this program with the Employment Coaches? *
Your answer
What's really important to you in life? How will this program help you achieve that? *
Your answer
What are some of your interests and/or hobbies? How might those things be explained as transferable skills in the IT field? *
Your answer
Please tell us about a time that you solved a technology-related problem. *
Your answer
Part 1c. Resources and Supports:
This section encourages you to think about the resources that you already have in your life and those you need to successfully complete this program. NOTE: Resources don't have to be things! (Think baby-sitters, transportation assistance, a car-pool buddy, a study buddy, access to a computer, etc.)
What support systems and resources do you already have in your life that can help you complete this 18-week program? *
Your answer
Please check all resources that may be helpful for you during this time: *
Part 1d. Problem Solving and Strategy Planning
Please think about what challenges may come up throughout the next 18-weeks and what actions you would take to work around them and reach your goals. We want you to be successful! Part of being successful comes from communicating what challenges you may face--whether they relate to child-care, transportation, physical and mental wellness, time management around other commitments, etc.
What things may affect your ability to actively participate in and complete an 18-week program? *
Your answer
What's one action that you are willing to put into place that could be a strategy to prevent this challenge from getting in the way of your success? *
Your answer
If there was something important around achieving your goal (to help you succeed or that could get in the way) that you haven't mention yet, what would it be? *
Your answer
List your top 3 motivators for completing this program? What or who is driving you to succeed with your IT career? *
Your answer
Congratulations! You've finished part #1 of the application process for the Computer User Support A+ ONLY Training Program at Center for Changing Lives! You must now complete part #2 of this application by attending as Assessment and Interview day at Center for Changing Lives.

If we do not get your online application BY September 10, 2017, and have not completed your Assessment and Interview day you will NOT be considered an applicant for the program.

For any questions on the application process please contact Resource and Connection Coordinator, Kayla Villalobos via email at with any questions or give her a call at (773) 342-6210 EXT 251.

Never submit passwords through Google Forms.
This form was created inside of Center for Changing Lives. Report Abuse - Terms of Service - Additional Terms