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AWWA Participant Data Sheet
Information on the participant information tab is only collected once, at the time of program entry. For Race/Ethnicity categories, please select all that apply.
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* Indicates required question
Participant ID
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
Social Security Number
*
Your answer
First Name
*
Your answer
Middle Name
*
Your answer
Last Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Transgender/ Gender Nonconforming
Choose not to answer
Sexual Orientation
*
Heterosexual
Bisexual
Homosexual
Pansexual
Asexual
Choose not to answer
Address (City, State, Postal Code)
*
Your answer
Race/Ethicity
*
American Indian/ Alaska Native
Asian
Black/ African American
Hispanic/ Latinx
Middle Eastern or North African
Native Hawaiian
Pacific Islander
White
Choose not to answer
Required
Do you identify as an individual with a Disability?
*
Yes
No
Choose not to answer
Employment Status
*
Full time
Part time
Temporary or Contract Employment
Internship or Apprenticeship
Unemployed
Choose not to answer
Are you a Veteran of the United States Armed Forces?
*
Yes
No
Individual Income
Your answer
Household Income
Your answer
Household Size
Your answer
Unemployment Compensation (UC) Eligible Status
Long-Term Unemployed
Dislocated Worker
Choose not to answer
Clear selection
Highest Level of Education Completed
*
Less than High School
High School
Community College
Advanced Degree
Choose not to answer
Immigrant?
Yes
No
Choose not to answer
Clear selection
Exhausted TANF/ Public Assistance (i.e. CalWorks)
Eligibility
Exhausting TANF within 2 Years
N/A
Clear selection
CalFRESH (i.e. food stamps) Recipient
*
Yes
No
SSI/SSDI Recipient
*
Yes
No
N/A
Foster Care Your Status
Homeless Individual/ Runaway Youth
N/A
Clear selection
Formerly Incarcerated/Justice- Involved Status
Yes
No
N/A
English Language Learner
Yes
No
N/A
Clear selection
Basic Skills Deficient/ Low Levels of Literacy
Yes
No
N/A
Single Parent
Yes
No
N/A
Clear selection
Displaced Homemaker
Yes
No
N/A
Clear selection
Migrant/ Seasonal Farmworker Status
Yes
No
N/A
Clear selection
Are you new to the industry or currently employed in the industry?
*
New Worker
Incumbent
Current Employer?
*
Your answer
Desired Occupation
*
Your answer
Desired Industry
*
Water
Waste Water
Energy
N/A
Required
How did you hear about this scholarship opportunity?
*
Your answer
Enrollment Date
MM
/
DD
/
YYYY
Exit Date
MM
/
DD
/
YYYY
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