Viable Pathways to Prosperity Intake Form

Please carefully complete each section of the form. The purpose of the form is to be completed by students interested in the Viable Pathways to Prosperity program. The submission is the first step in the process. We will be in touch with next steps.

Student First Name*

Student Last Name*

Student Address*

Student Phone Number*

Phone

Personal E-Mail*

Student Drivers License Number

Are you currently in a Hamilton Co. High School?*

Select

What High School do/did you attend?*

Select or enter value

What high school did you graduate from?*

Select

Graduation Date*

Pathway of Interest?*

Select

Why are you interested in this pathway?*

How did you hear about this program?*

Select or enter value

Learn and Earn Opportunity*

Do you understand that this is a learn and earn opportunity and trainees will be expected to conduct themselves as professionals: showing up on time, providing consistent growth, showing up ready to learn, respectful, and committed to this career pathway?

Select

Future Employment*

This pathway is designed to prepare and place someone into employment. Are you prepared to take a job in this field if a position is offered to you upon completion of the pathway?

Select

SNAP Eligibility

Have you or your family ever qualified for SNAP?

Select

File Upload*

Please upload your eligibility letter.

Drag and drop files here or

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