RiseKit Staff

Your Name, Phone, and Email Address

Name *

Email

Phone

Either email or phone is required *

Date of Birth *

Social Security Number *

Full Address (*Required) *

Please include full address with street, city, state and ZIP

Citizenship Status *

US Citizen

Permanent Resident

Visa Holder

Not a US Citizen

What is your preferred language? *

Emergency Contact *

Include name, phone and relationship of your emergency contact.

Gender *

Male

Female

Transgender male

Transgender female

Nonbinary

Agender

Two-spirit

Prefer not to say

Race *

Asian

Black or African American

Latin American

Native American or Alaskan Native

Caucasian

Mixed ethnicity

Native Hawaiian or Pacific Islander

Middle Eastern or Arab

Prefer not to share

Veteran Status *

Veteran

Eligible Spouse of a Veteran

Not a Veteran

Disability Status *

If yes, please provide information on disability

Yes

No

Highest Education Level Completed *

Less than High School (Did not complete)

High School Diploma

GED/HiSET/High School Equivalency

Some College, No Degree

Certificate or Industry Credential

Associate Degree

Bachelor's Degree

Master's Degree or Higher

Choose Your Occupational Credential *

Healthcare Specialist Apprenticeship - Certified Nursing Assistants

Healthcare Specialist Apprenticeship - Phlebotomist

Healthcare Specialist Apprenticeship - Patient Care Technicians

Healthcare Specialist Apprenticeship - Clinical Medical Assistants (CMA)

Advanced Patient Care Technician (APCT)

Mental Health Technician (MHT) – Healthcare & Behavioral Health Pathway (CNA requirement)

Animal Care - Grooming Salon Assistant

Creative Industries - Musician Artist Development Specialist

ServSafe - Culinary Workforce Specialist

Choose Your Professional Workforce Credential *

Lean Six Sigma White/Yellow/ Green Belt

Lean Six Sigma White/Yellow Belt

Certified Associate in Project Management (CAPM) Exam Preparation

Society for Human Resources Management- SHRM (Essentials)

Microsoft Office Specialist (MOS)

Are you able to commit to the full duration of the training program, including any required assignments or projects? *

Yes

No

What barriers are you experiencing? *

Employment Status *

Unemployed

Full-time

Part-time

Who is your Current Employer?

Are you the parent or guardian of a child 18 years old or younger who shares primary residence with you? *

Yes

No

Are you currently receiving TANF (Temporary Assistance for Needy Families or Cash Assistance)? *

Yes

No

Are you currently eligible for or receiving Medicaid, SNAP (Supplemental Nutrition Assistance Program), Families First, public housing assistance, Section 8, National School Lunch Program or free/reduced lunch? *

Yes

No

If you are working part-time and selected "No" to receiving SNAP, Medicaid and/or Section 8 housing can you provide Proof of Annual Income at or at Below the Federal Poverty level? (Paycheck stubs, employer statement, alimony statement, compensation award letter, public assistance records, unemployment income (UI) documents, letter or printout, proof of tax or self-employed schedule C, Social Security Benefits records or letter, Disability records, Layoff WARN notice, or tax documents?)

Yes

No

Are you interested in tuition assistance? *

Yes

No

How did you hear about 2Unique Registered Apprenticeship program? *

Shelby County Schools CCTE

Job/Career Fair

Recommended by a friend or colleague

2Unique Website

Social Media

Search Engine

Other

Do you grant us permission to take photos and video for promotional use? *

Yes, I grant permission for promotional photography and video

No, I do not grant permission for promotional photography and video

2Unique Community Salvation Foundation - 2 Unique Application

Personal Information

Your Name, Phone, and Email Address

Demographic Information

Pre-Apprenticeship Program Interests

Additional Information