My Next Career Move, Oct. 22 - Nov. 19, 2019
If you require accommodations to participate in this class, please contact Melinda Wildes at 593-7942 or melinda.wildes@maine.edu

​Thank you for providing the following information. Your name and contact information will not be shared. Aggregate data is used for the pu​rposes of reporting to our funders and measuring the success of our programs.

​All fields are required on the registration form. Please contact ​Melinda Wildes at 593-7942 or melinda.wildes@maine.edu if you prefer a paper copy or have any questions​. If you have taken a class with NVME recently, contact the trainer. Your registration information may already be on file.​

​​You may be contacted in the future to provide feedback on your experience with NVME.​
Name *
Date of Birth *
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Street Address *
City, State, Zip *
Email *
Phone number *
How did you hear about us? *
Sign me up for the email news about our programs? *
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Gender *
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Are you of Franco-American heritage?
Clear selection
I consider myself Hispanic or Latino.
Clear selection
In addition, check one or more of the following.
Work Status *
Required
I have a disability that limits my work *
Required
I receive SSI, SSDI, or veterans disability? *
Required
I am a veteran, active duty military or reservist *
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I receive unemployment insurance (UI)? *
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I am actively looking for work *
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Education Information *
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Are you currently enrolled in school? *
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If you are currently a student, what kind of program are you enrollled in?
Major field of study?
Are you a University of Maine Augusta student? *
Number of people in your household including you *
Total monthly Income for your household (from all sources) *
Health Insurance coverage (choose one) *
Are you Head of Household? *
Are you a single parent? *
Do you receive food stamps? *
Do you receive TANF? *
Do you have savings? *
Do you have retirement savings? *
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