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UpSkill Work and Learn student interest form:
This form does not commit you to the program but will allow you to show interest. Once it is complete you will receive an email, text or phone call to discuss the program in more detail.
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Email
*
Your email
First Name
Your answer
Last Name
Your answer
High School
Choose
Academy of Science & Entrepreneurship
Barr-Reeve High School
Bloomfield High School
Brown County High School
Eastern Greene High School
Edgewood High School
Loogootee High School
Mitchell High School
North Lawrence Career Center
Orleans High School
Owen Valley High School
Salem High School
Shoals High School
Washington High School (Daviess County)
West Washington High School (Washington County)
If Other, What school do you attend?
Your answer
By providing your phone number below, you consent to receive text messages from Regional Opportunity Initiatives. You can opt out at any point by texting STOP.
Phone Number
Your answer
If you do not have a cell phone, is there another way we can contact you?
Phone call
Email
Clear selection
Gender
Choose
Male
Female
Prefer not to answer
Grade level
Choose
Freshman
Sophomore
Junior
Senior
Are you in a Career Pathway at school?
Architecture and Construction
Advanced Manufacturing
Business Management, Administration, Marketing & Finance
Health Science or Biotechnology
Information Technology (IT)
Transportation, Distribution & Logistics
My school does not have career pathways
Other:
Do you currently have your driver's license?
Your answer
Do you participate in any sports or extra-curricular activities?
Your answer
What makes you interested in the UpSkill program?
Your answer
What questions can we help you answer?
Your answer
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