Open Door Institute Culinary Arts Training Program
Eligibility Form

If you have any questions or concerns, please contact Octavia office phone: 706.323.5518 or email: octavia@odch.org

Application Deadline: Wednesday, July 2, 2021
Today's Date *
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Name: *
Date of Birth *
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Age *
Gender *
Race/Ethnicity *
Address: *
Current living situation: *
If YES for shelter, which shelter do you stay in?
Phone Number *
Email address *
Current Monthly Income (before taxes): *
Are you currently working? *
If YES, where are you currently working?
Household Size *
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Adults (over 18 years old)
Kids (17 years old and younger)
Highest Level Of Education *
Do you need accommodations for a learning disability, ADD, ADHD, physical disability (temporary/permanent), or emotional or mental health conditions? *
If yes, how can we help to accommodate your need:
How did you hear about our program? *
Required
Referred from which agency?
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