ITXpress Program Application
(All personal information you provide will be kept strictly confidential and will be used only for program purposes. Do not leave any section blank. Write N/A if it doesn't apply to you.)
Email Address (Only Gmail accounts are acceptable. If you do not have a Gmail account, please create one). *
Your answer
Date of birth (program is restricted to persons age 17 through 29. Please do not continue with this application, if you are not within this age range). *
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Are you currently enrolled in high school, or any other form of higher education (e.g., college)? This program is ONLY for individuals who already possess a high school diploma or GED, and are not currently enrolled in any form of higher education. *
Are you a Connecticut resident? The ITXpress Program is only for CT residents. *
Full Name *
Your answer
Gender *
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Apartment number or floor (Enter "N/A" if not applicable) *
Your answer
Phone: *
Your answer
How did you hear about the ITXpress Program? *
Your answer
Which ITXpress Training Location would you prefer? *
Do you consider any of the following to be barriers to obtaining training and employment in the Information Technology field? Please select those that are barriers. Preference will be given to candidates who face barriers to full-time employment. (Select N/A if none are applicable) *
Required
If your application to the ITXpress program is accepted, are you willing and able to attend all classes, and to keep all weekly appointments with an ITXpress Career Navigator? *
Why are you interested in the ITXpress program? *
Your answer
Describe briefly any experience you've had with Information Technology or computers. *
Your answer
Where did you attend high school? *
Your answer
Did you graduate? *
did you take any I.T. courses in high school? *
Your answer
Have you attended college? *
If so, where (enter "N/A" if not applicable): *
Your answer
When? (enter "N/A" if not applicable) *
Your answer
Did you take any I.T. courses in college? (enter "N/A" if not applicable) *
Your answer
Do you have a college degree? *
Your answer
Are you employed? *
If yes, full-time or part-time? *
Have you ever been employed? *
If yes, what was your occupation? (enter "N/A" if you have never been employed) *
Your answer
Are you willing to move in order to obtain employment in the Information Technology field? *
Are you collecting unemployment benefits? *
If so, when did you begin collecting (month & year)(enter "N/A" if not applicable) *
Your answer
Do you have a driver's license? *
Do you have a reliable vehicle & insurance? *
Do you rely mainly on public transportation? *
Do you have some familiarity with any of the skills and credentials listed below? Check the ones that apply: *
Required
Do you have any other computer skills or familiairty with other credentials that are not listed above? Please write "N/A" if not applicable. *
Your answer
Describe your familiarity with the skills or credentials that you check above (write "N/A" if you did you not select any). *
Your answer
Day classes fill up quickly. Would you be interested in night classes? *
Do you have a disability (that is, physical or mental impairment that substanially limits one or more of the person's major life activities)? *
Are you of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture origin, regardless or race? *
Are you a member of an Indian Tribe, band, nation or other organized group, including Alaska Native? *
Are you Black / African American? *
Are you Native Hawaiian or other Pacific Islander? *
Are you White (having origins in any of the original peoples of Europe, the Middle East, or North Africa)? *
Are you a person who served in the active U.S. military, naval, or air service for a period of less than or equal to 180 days, and who was discharged or released from such service under conditions other than dishonorable? *
Are you a person who served in the active U.S. military, naval, or air service for a period of less than or equal to 180 days, and who was discharged or released from such service under conditions other than dishonorable? *
Have you served on active duty for a period of more than 180 days and was discharged or released with other than a dishonorable discharge; or was discharged or released because of a service connected disability; or as a member of a reserve component under an order to active duty pursuant to section 167(a), (d), or (g), 673 (a) of Title 10, U.S.C., served on active duty during a period of war or in a campaign or expedition for which a campaign badge is authorized and was discharged or released from such duty with other than a dishonorable discharge? *
Are you the spouse of any person who died on active duty or of a service connected disability? *
Are you the spouse of any member of the Armed Forces serving on active duty who at the time of application for assistance under this part, is listed, pursuant to 38 U.S.C 101 and the regulations issued there under, by the Secretary concerned, in one or more of the following categories and has been so listed for more than 90 days: i. Missing in action; ii. Captured in the line of duty by a hostile force; or iii. Forcibly detained or interned in the line of duty by a foreign government or power? *
Are you the spouse of any person who has a total disability permanent in nature resulting from a service connected disability or the spouse of a veteran who died while a disability so evaluated was in existence? *
Are you currently performing any work at all as a paid employee, (b) currently performing any work at all in his or her own business, profession, or farm, (c) currently performing any work as an unpaid worker in an enterprise operated by a member of the family, or (d) one who is not working, but currently has a job or business from which you are temporarily absent because of illness, bad weather, vacation, labor-management dispute, or personal reasons, whether or not paid by the employer for time-off, and whether or not seeking another job? *
Are you a person who, although employed, either (a) has received a notice of termination of employment or the employer has issued a Worker Adjustment and Retraining Notification (WARN) or other notice that the facility or enterprise will close, or (b) is a transitioning service member (i.e., within 12 months of separation or 24 months of retirement)? *
Aree you a person who is not in the labor force (i.e., you are not employed and are not actively looking for work, including those who are incarcerated)? *
Are you not employed but are seeking employment, and you make a specific effort to find a job, and you are available for work? *
Have you been unemployed for 27 or more consecutive weeks? *
How many grades of high school have you completed? (0-12) *
Have you obtained a secondary school diploma? *
Have you obtained something equivalent to a secondary school diploma? *
D you have a disability and attained a certificate of attendance/completion as a result of successfully completing an Individualized Education Program (IEP)? *
D you have a disability and attained a certificate of attendance/completion as a result of successfully completing an Individualized Education Program (IEP)? *
Have you completed one or more years of postsecondary education? *
Have you attained a postsecondary certification, license, or educational certificate (non-degree)? *
Have you attained an Associate's degree? *
Have you attained a Bachelor's degree? *
Have you attained a degree beyond a Bachelor's degree? *
Have you every been the subjected to any stage of the criminal justice process for committing a status offense or delinquent act, or do you require assistance in overcoming barriers to employment resulting from a record of arrest or conviction? *
Do you receive, or in the 6 months prior to this application have received, or do you have a family member that is receiving or in the past 6 months prior to this application has received: i. Assistance through the supplemental nutrition assistance program (SNAP) under the Food and Nutrition Act of 2008 (7 USC 2011 et seq.); ii. Assistance through the temporary assistance for needy families program under part A of Title IV of the Social Security Act (42 USC 601 et seq.); iii. Assistance through the supplemental security income program under Title XVI of the Social Security Act (42 USC 1381); or iv. State or local income-based public assistance? *
Are you in a family with a total family income that does not exceed the higher of the poverty line or 70% of the lower living standard income level? *
Are you a youth who receives, or is eligible to receive a free or reduced price lunch under the Richard B. Russell National School Lunch Act (42 USC 1751 et seq.)? *
Are you a foster child on behalf of whom State or local government payments are made? *
Are you a person with a disability whose own income is the poverty line but who is a member of a family whose income does not meet this requirement? *
Are you a homeless? *
Do you live in a high poverty area? *
Do you have a limited ability in speaking, reading, writing or understanding the English language? *
Is your native language a language other than English? *
Do you live in a family or community environment where a language other than English is the dominant language? *
By signing this application in the textbox below, I affirm the following as accurate and truthful: I am between the ages of 17 and 29, and am a U.S. citizen or a permanent resident. I am out of school and do not intend to return to school or college in the near future. I acknowledge that the ITXpress Program is a non-credit vocational training and employment program that is an alternative to attending college. I am unemployed (or working part-time) and have a barrier to employment. I will, if admitted to the program, attend classes faithfully and participate fully, and keep in touch with my Career Navigator. I intend to vigorously pursue full time IT employment immediately upon completion of ITXpress Program training. I give permission to Workforce Alliance to conduct a background check. I understand that this is a drug free program and that the use of illicit substances will result in termination. I understand that participants are not paid for attending training, and that upon completion, employment is not guaranteed. *
Your answer
Date: *
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The ITXpress program is funded by an H-1B TechHire Partnership grant (HG29357) from the U.S. Dept. of Labor Employment and Training Administration. The workforce board is an Equal Opportunity Employer. Auxiliary aids and services are available upon request to individuals with disabilities.
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