NHS of Queens' Latinx @ Work: Digital Literacy Classes Application - Cohort 4 (Waitlist)
This is an application for Cohort 4, starting on Early October. Interested candidates will be contacted two weeks prior to the beginning of classes, and mores details will be disclosed as we approach the starting date.


*** Any changes will be disclosed to all participants in advanced ***

Please note that you must answer all the questions to the best of your ability to be considered for the program. Upon submitting an application, candidates will then be interviewed via phone before final selection. Candidates that are not selected are welcome to reapply again in our next cohort. Any and all information you provide will only be shared with the program grantor for demographic purposes. Your identity will remain anonymous.

If you have any questions, please email at jsantos@nhsofqueens.org or rmurphy@nhsofqueens.org


First Name *
Last Name *
Address *
City *
State *
Zip Code *
Phone Number *
Select your preferred class times:
(Class Hours Subject to change)
*
Date of Birth *
MM
/
DD
/
YYYY
Current Level of Education *
Do you have the permits to work in the US? *
Are you currently employed? *
If Working - What is your Hourly Wage?
Do you currently own a computer with WiFi at home? *
Gender *
Transgender *
Sexual Orientation *
Ethnicity *
Race *
Person with Disabilities? *
Household Income *
Are your children receiving Free or Reduced Lunch? *
NHSQ CDC is funded through a variety of sources to support its mission. These funding sources include government agencies, foundations, private organizations, and financial institutions.  These programs/services may also be offered by other providers, and clients are under no obligation to choose any of these particular loan products or programs that are provided through NHSQ CDC. I, the client, understand that I am not obligated to receive any other services offered by NHSQ CDC or its exclusive partners. NHSQ CDC will provide information on alternative services, programs and products upon request.  I understand that my name will not be shared with other parties, but that other information gathered may be used for research, program or policy development, or other legitimate purposes by relevant funders including but not limited to government agencies, foundations, private organizations, and financial institutions  By clicking, "I Agree" below, you are providing us with a form of eSignature to the disclosure above. *
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