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FANTIC Application
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* Indicates required question
Today's Date
DD
/
MM
/
YYYY
First Name
*
Your answer
Middle Name
Your answer
Last Name
*
Your answer
Street Address/P.O. Box
*
Your answer
APT #
Your answer
Town/City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Last four Digits of Social Security Number
*
Your answer
Date of Birth
*
DD
/
MM
/
YYYY
Phone Number
Your answer
Daytime Phone Number
*
Your answer
Email
*
Your answer
Highest Education Attained
*
Some High School
High School Graduate/GED
Some College/Trade School
Associate/Trade School Degree
Bachelor’s Degree
Master’s Degree
Ph.D. or Ed.D.
Any Certifications or credentials held
*
List any certifications or credentials held. If you do not have any certifications or credentials, put NA or none.
Your answer
Age Verification (must be 18 years or older):
*
Driver's License
Birth Certificate
State-Issued ID
Passport
High School Transcript
High School Diploma
Required
Check YES or NO to the following questions to help us determine if FANTIC is appropriate for you. See instructions on how to answer question following the list of questions.
Are you currently unemployed?
*
Yes
No
Are you eligible for or receiving unemployment benefits?
*
Yes
No
If you are employed, have you been laid off in the last 20 months and is your current job an interim or temporary position?
*
Yes
No
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