Training Assistance Portal "*" indicates required fields Choose Your Career Path:* Please choose one...Manufacturing (Skill Up)Health career (HCAP) Please indicate which sector or specific training program that interests you. You will receive a follow-up email for your choice. Name:* First Last Email:* Cell Phone (area code)* Home Phone? ( same as cell) Street Address* City of Residence: (choose one)* "Choose one, etc"AndoverAnsoniaAshfordAvonBarkhamstedBeacon FallsBerlinBethanyBethelBethlehemBloomfieldBoltonBozrahBranfordBridgeportBridgewaterBristolBrookfieldBrooklynBurlingtonCanaanCanterburyCantonChaplinCheshireChesterClintonColchesterColebrookColumbiaCornwallCoventryCromwellDanburyDarienDeep RiverDerbyDurhamEastfordEast GranbyEast HaddamEast HamptonEast HartfordEast HavenEast LymeEastonEast WindsorEllingtonEnfieldEssexFairfieldFarmingtonFranklinGlastonburyGoshenGranbyGreenwichGriswoldGrotonGuilfordHaddamHamdenHamptonHartfordHartlandHarwintonHebronKentKillinglyKillingworthLebanonLedyardLisbonLitchfieldLymeMadisonManchesterMansfieldMarlboroughMeridenMiddleburyMiddlefieldMiddletownMilfordMonroeMontvilleMorrisNaugatuckNew BritainNew CanaanNew FairfieldNew HartfordNew HavenNewingtonNew LondonNew MilfordNewtownNorfolkNorth BranfordNorth CanaanNorth HavenNorth StoningtonNorwalkNorwichOld LymeOld SaybrookOrangeOxfordPlainfieldPlainvillePlymouthPomfretPortlandPrestonProspectPutnamReddingRidgefieldRocky HillRoxburySalemSalisburyScotlandSeymourSharonSheltonShermanSimsburySomersSouthburySouthingtonSouth WindsorSpragueStaffordStamfordSterlingStoningtonStratfordSuffieldThomastonThompsonTollandTorringtonTrumbullUnionVernonVoluntownWallingfordWarrenWashingtonWaterburyWaterfordWatertownWestbrookWest HartfordWest HavenWestonWestportWethersfieldWillingtonWiltonWinchesterWindhamWindsorWindsor LocksWolcottWoodbridgeWoodburyWoodstock Zip Code:* Date of Birth (MM/DD/YYYY):* MM slash DD slash YYYY Must be at least 18 years old. Age:* Please enter a number from 18 to 99. Gender:* "Choose one, etc"MaleFemaleChoose Not to Respond What is your race/ethnicity?Check all that apply.* Black or African American Asian American Hispanic, Latino or Spanish Origin Caucasian Native American or Alaska Native Pacific Islander or Native Hawaiian Choose not to answer Are you a U.S. military veteran? "Choose one, etc"* YesNo Is your spouse either an active member of the U.S. military or a veteran? "Choose one"* "Choose one, etc"YesNo Do you have a disability? This may be a physical, mental or other documented disability. Auxiliary aids are provided upon request.* "Choose one, etc"YesNoChoose not to answer Number of Children in Your Household Under 18: (Please enter a number from 0 to 6)* Please enter a number from 0 to 6. Please List Ages for Any Children Under 18 (For Example: 2, 4, 6): What is your current employment status?* Not WorkingWorking Part TimeWorking Full TimeNever Worked - Not Employed Have you received a lay-off notice? YesNo Are you currently receiving Unemployment compensation? YesNo If you are working, please enter your hourly rate of pay. For example, 15.00: If your current job is temporary, enter your end date (MM/DD/YYYY): MM slash DD slash YYYY Current school status:* Not attending schoolAttending post-high school institution Highest grade completed:* High School Diploma/GEDTrade or Technical SchoolSome CollegeBachelors DegreeSome Post-GradMasters DegreePhD or Other Doctorate8-11th Grade Only Have you received Job Training or Placement assistance from Workforce Alliance or the American Job Centers in the last 2 years?* Yes No Are you a U.S. citizen and able to work in the United States?* Yes No If no, please answer the next question. If you are NOT a citizen, can you provide documentation that you are eligible to work in the United States? Yes No FOR PLANNING PURPOSES ONLY. Your answers to the next 2 questions DO NOT affect your eligibility. Do you have unlimited access to a computer or laptop?* Yes No Do you have access to reliable internet in your home?* Yes No How did you hear about us?* Brochure/NewsletterSocial Media (Facebook, Twitter, Instagram etc)Digital Marketing (youtube,CT TV, google)Bus AdvertisementPoster/FlyerNewspaper AdSchool counselorFamily Friend CAPTCHA
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