Registration for Introduction to Self-Employment, ONLINE, Wednesday, August 19, 2020, 12:00

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Registration for Introduction to Self-Employment, ONLINE, Wednesday, August 19, 2020, 12:00 - 1:00 p.m.

If you require accommodations to participate in this class, please contact Gigi Guyton at 207-799-5025 or gigi.guyton@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 Gigi Guyton at 207-799-5025 or gigi.guyton@maine.edu. If you prefer a paper copy or have any questions. If you have taken a class with NVME recently, contact Gigi. Your registration information may already be on file.

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

Name - First *

Name - Middle

Name - Last *

Date of Birth *

年

月

日

Street Address *

City *

State *

Zip Code *

Email *

Phone number *

Alternate phone number

How did you hear about us? *

Sign me up for the email news about NME programs, *

Yes

必填

Gender *

Female

Male

Undisclosed

其他:

必填

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

Are you of Franco-American heritage? *

Yes

Unsure

Do you consider yourself Hispanic/Latino? *

Yes

Unsure

Race-check one box only *

White

Asian

Native Hawaiian or Pacific Islander

Black or African American

Native American or Alaska Native

必填

Work Status *

Employed full-time

Employed part-time or seasonal

Unemployed

Self-Employed

Retired/semi-retired

必填

I have a disability that limits my work *

Yes

必填

I receive SSI, SSDI, or veterans disability? *

Yes

必填

I am a veteran, active duty military or reservist *

Yes

必填

I receive unemployment insurance (UI)? *

Yes

必填

I am actively looking for work *

Yes

必填

Education Information *

Did not complete high school

High school dimploma/HiSET/GED

College coursework

Trade school certificate

Associate degree

Bachelor degree

Post-bachelor coursework

Graduate degree

Other

必填

Are you currently enrolled in school? *

Yes

必填

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

HS/HiSET

College prep

Trade School Certificate

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

Some members

All household members

No one

Are you Head of Household? *

Yes

Are you a single parent? *

Yes

Does your household receive food stamps? *

Yes

Does your household receive TANF? *

Yes

Do you have savings? *

Yes

Do you have retirement savings? *

Yes

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