Registration for Introduction to Self-Employment, ONLINE, Wednesday, November 18, 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.​
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Name - First *
Name - Middle
Name - Last *
Date of Birth *
MM
/
DD
/
YYYY
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, *
Required
Gender *
Required
If you would like the opportunity, we invite you to say more about your gender identity here:
Are you of Franco-American heritage? *
Do you consider yourself Hispanic/Latino? *
Race-check one box only *
Required
Work Status *
Required
I have a disability that limits my work *
Required
I receive SSI, SSDI, or veterans disability? *
Required
I am a veteran, active duty military or reservist *
Required
I receive unemployment insurance (UI)? *
Required
I am actively looking for work *
Required
Education Information *
Required
Are you currently enrolled in school? *
Required
If you are currently a student, what kind of program are you in?
Major field of study?
Are you a University of Maine Augusta student? *
Number of people in your household including you *
Total  monthly Income for your household (from all sources) *
Health Insurance coverage (choose one) *
Are you Head of Household? *
Are you a single parent? *
Does your household receive food stamps? *
Does your household receive TANF? *
Do you have savings? *
Do you have retirement savings? *
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