Training Application
Date
MM
/
DD
/
YYYY
First Name
Last Name
Current Street Address
City
State
Zip Code
Current Phone Number
Email Address
Preferred Class Location
Bethel Neighborhood Center
Gathering Table
1st Choice
2nd Choice
Clear selection
Languages Experience
Read
Understand
Speak
Write
Native Language
English
Other
Clear selection
Referral Agency
Country of Origin
Date Entered U.S.
MM
/
DD
/
YYYY
Goals for Applicant (check all that apply)
Job Skills Needed:
I have received the: Covid -19 vaccine
Clear selection
If yes, Date of first shot:
MM
/
DD
/
YYYY
Date of second shot:
MM
/
DD
/
YYYY
I have received the: Flu vaccine
Clear selection
If yes, Date:
MM
/
DD
/
YYYY
Photo approval: Photos are taken of class groupings and individuals to use for promotional items for Once We Were Refugees. Each student has the option to agree with our using photographic images of them and their work in our advertising—both print and on-line.I agree with photos of me being used for this purpose
Clear selection
Student Signature (Type if completing online)
Submit
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