Covid 19 VA Fast Trak Assistance Application
Please fill out the form below to see if you are a candidate for assistance and admission into our program.
First Name *
Last Name *
Email Address *
How have you been financially impacted by Covid 19? *
Has your job/career been directly impacted by Covid-19? If yes, how? *
Can you provide proof of impact of Covid-19? If yes please email to bri@theraxx.com *
Would you be able to make a donation in lieu of the full course payment for administrative fees? *
What type of donation could you make? *
Submit
Never submit passwords through Google Forms.
This form was created inside of Brianne Sanford. Report Abuse