More Than A Job NC Program Interest Form

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Email *

First Name *

Middle Initial

Last Name *

Date of Birth *

YYYY

Address *

City, State, Zip *

County of Residence *

Phone *

Do you currently receive FNS Benefits? *

Yes

Unsure, but I would like assistance applying if eligible.

How did you first hear about the Employment and Training Program? *

Program of Interest: *

I would like to pursue my High School Equivalency

I would like to pursue a workforce credential/certificate (Biowork, Cosmetology, CDL, Forklift Operator, Nurse Aide I, Nurse Aide II, Phlebotomy, Pharmacy Technician, ServSafe Food Service)

I would like to pursue an A.A.S. Degree or certificate (transfer programs excluded)

Other:

A copy of your responses will be emailed to the address you provided.

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