Please fill out to the best of your ability. We will contact you after receiving your application.
Please note: Your answers are confidential. They are for office purposes only.
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Applying to Men's or Women's program?
First & Last Name
How did you hear about us?
Do you have access to a computer?
Do you have reliable Internet access?
What is your goal upon program completion?
Full Time Work
Part Time Work
Just Interested in Skills
Opening Own Business
Select your highest level of schooling:
High School Diploma
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This form was created inside of Jewish Community Council of Greater Coney Island, Inc.