Student Applications

Student Application

* We are currently only taking application for Illinois, Missouri and Indiana Students Only. This program is only open to American Citizens and Permanent Residents (Green Card Holders)

First Name*

Last Name*

Address

City*

State*

Zipcode*

Phone*

Email*

Select any public benefits programs that you are receiving*

SNAP

TANF

Unemployment Insurance (U.I)

Other

Have you received Education Grants? i-e WIOA?*

Yes WIOA

Other

Are you currently employed?*

Yes

Other benefits

Your Age*

Household Size*

What's your annual household income?*

Have you been laid off or let go by an employer within last 5 years?*

Yes

Are you a*

US Citizen

Permanent Resident

On a scale of 0 to 10, how would you rate your own proficiency with technology?

Please Select

Please Select
0 – No experience at all
1 – Very limited experience
2 – Basic familiarity with common tools
3 – Can perform simple tasks independently
4 – Comfortable with everyday applications
5 – Average user; can troubleshoot basic issues
6 – Above-average; can adapt to new tools quickly
7 – Proficient with a range of digital tools and platforms
8 – Strong technical skills; able to support or train others
9 – Very advanced; can solve complex problems
10 – Expert level; can build or manage technical systems

LinkedIn Profile

Resume

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Please provide your Career coaches Name.

Please provide your Career coaches Email Address

Best Time to Call

Please Select

Please Select
9:00 am -12:00 pm
12:01 pm - 5:00 pm
5:01 pm - 7:00 pm

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