Milestone Application

Milestone Application

Name(First and Last)*

Today's date

Phone Number

Email

Age

Birth Date*

Gender*

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What is your Current Living Situation?

Do you have reliable transportation

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Are you currently employed

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If yes, Where

How did you hear about the program?

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If other, how did you hear about the program

Are you currently in School

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If yes, where?

Highest level of education completed

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What are your goals over the next 2 Years*

Send me a copy of my responses

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