Register for Making Career Choices (Formerly Exploring Careers), Tuesday, August 4, 2020, 10:00

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If you require accommodations to participate in this class, please contact Tom Grogan at 207-263-7843 or thomas.grogan@maine.edu.

Thank you for providing the following information. Your name and contact information will not be shared. Aggregate data is used for the purposes of reporting to our funders and measuring the success of our programs.

All fields are required on the registration form. Please contact Tom Grogan at 207-263-7843 or thomas.grogan@maine.edu if you prefer a paper copy or have any questions. If you have taken a class with NVME recently, contact the trainer. Your registration information may already be on file.

You may be contacted in the future to provide feedback on your experience with NVME.

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عنوان بريد إلكتروني *

Name - First *

Name - Middle

Name - Last *

Date of Birth *

شهر

YYYY

Address *

City *

State *

Zip *

Email *

Phone number *

Alternate phone number

How did you hear about us? *

Sign me up for the email news about our programs? *

Yes

مطلوب

Gender

Female

Male

Undisclosed

أخرى:

If you would like the opportunity, we invite you to say more about your gender identity here:

If you are of Franco-American heritage, please check here. *

Yes

Unsure

مطلوب

If you consider yourself Hispanic or Latino, please check here. *

Yes

Unsure

مطلوب

In addition, check one or more of the following racial categories to describe yourself. *

White

Asian

Native Hawaiian or Pacific Islander

Black or African American

Native American or Alaska Native

Other - check here and continue to the next question.

مطلوب

If you chose other above, please list here.

Work Status *

Employed

Employed part-time or seasonal

Unemployed

Self-Employed

Retired/semi-retired

مطلوب

I have a disability that limits my work *

Yes

مطلوب

I receive SSI, SSDI, or veterans disability? *

Yes

مطلوب

I am a veteran, active duty military or reservist *

Yes

مطلوب

I receive unemployment insurance (UI)? *

Yes

مطلوب

I am looking for work *

Yes

مطلوب

Education Information *

Did not complete high school

High school dimploma/HiSET/GED

College coursework

Trade School certificate

Associates Degree

Bachelors Degree

Post-bacculete coursework

Graduate degree

Other

مطلوب

Are you currently enrolled in school? *

Yes

مطلوب

If you are currently a student, what kind of program are you enrolled in?

HS/HiSET/GED

College prep

Trade School

Associates Degree

Bachelor Degree

Graduate Degree

Major field of study?

Are you a University of Maine Augusta student? *

Yes

Number of people in your household including you *

Total monthly Income for your household (from all sources) *

Health Insurance coverage (choose one) *

Self - if household of one with insurance, select this option

Some members

All household members

No one

Are you the Head of Household? *

Yes

Are you a single parent? *

Yes

My household receives food stamps. *

Yes

My household receives TANF. *

Yes

I have savings. *

Yes

I have retirement savings. *

Yes

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