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* Indicates required question
How did you hear about our program? (Check what applies)
*
Social Media (FB or Instagram)
Recruiter at a table that was set up
Service agency referral
Family
Friend
Flyer
Other:
Required
Name (First Name & Last Name)
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
Program of Interest
*
Shipping and Receiving
Woodworking
CEJA
CNA (Currently only for high school seniors)
West Town Academy High School
YCCS-West High School
Other:
Required
Recruiter's/Personnel's Name
*
Mr. Timothy White
Mr. Vernell Mattox
Mr. Keith Muhammad
Not Applicable
Other:
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