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

Upload

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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