Renter's Education Registration

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What is your Name? *

What is your Date of Birth? *

YYYY

Which workshop are you interested in? *

Community Action: 2nd Wednesday of every month from 2-4p

Helping Hands Solution Center: Only available for groups (4+) during summer

Community Action: 4th Wednesday of every month from 2-4p

Required

What is the date of the workshop?

YYYY

Please provide a phone number and/or email account for us to contact you. *

What is the best way to contact you?

Phone

Other:

Clear selection

How did you hear about this workshop?

These questions are for potential referrals for other Community Action services and resources. They do not impact your registration.

Yes

More information please

Have you ever served in the United States Military?

Is anyone in your household pregnant or have children under five years old?

Do you receive Basic Food Assistance?

Are you seeking employment?

Do you receive Energy Assistance?

Are you interested in getting your GED?

Are you interested in meeting one-on-one with a Financial & Job Coach to set, clarify, and maintain your goals?

Yes

More information please

Have you ever served in the United States Military?

Is anyone in your household pregnant or have children under five years old?

Do you receive Basic Food Assistance?

Are you seeking employment?

Do you receive Energy Assistance?

Are you interested in getting your GED?

Are you interested in meeting one-on-one with a Financial & Job Coach to set, clarify, and maintain your goals?

Clear selection

Submit

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