Youth Employment and Training Programs Interest Form

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Form for those interested in EASTCONN's Youth Employment Program.

Your e-mail address *

Your First Name *

Your Last Name *

Your Phone Number *

Your town of residence *

School attended by student (if applicable)

Grade level of student (if in school)

Are you interested in one or more of the following career fields? *

Manufacturing

Healthcare

Information Technology

Other

Undecided

Required

If you answered "Other" please describe the career field(s) you are interested in.

How did you hear about the Connecticut Youth Employment and Training Program (including COOL Directions)? *

I give my permission to provide Personal Identifiable Information as referenced in the Personal Identity Information Policy contained within the Connecticut Department of Labor Workforce Innovation Opportunity Act Manual. *

I acknowledge that I have read this statement and I give my permission to provide Personal Identifiable Information below.

Submit

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