Career & Job Training Program Application

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Page 1

Personal Information





















A copy of your official Social Security card is required. Handwritten versions are not acceptable.


This question is related to homelessness.

Citizenship







Immigrant - Any person lawfully in the United States who is not a U.S. citizen, U.S. national, or person admitted under a nonimmigrant category as defined by the Immigration and Nationality Act (INA) section 101(a)(15).

Refugee - Status granted to an individual, prior to departure for and arrival in the United States, who has been determined by competent authority to be fleeing persecution or have a well-founded fear of persecution in their own country because of race, religion, nationality, membership in a particular social group or political opinion.
Emergency Contact Information



Program of Interest



Please note that this training will require students to undergo a background check and a tuberculosis (TB) test.




Family/Income Status


Make sure to include yourself.


Include your estimated income. If you have a spouse, include the total estimated annual income for both you and your spouse.

Page 2

Employment




If yes, please fill out current employer information below:





Education


An IEP is a written plan developed for a student identified with a disability by a team of education professionals, the parent/guardian, and the child (when appropriate) that describes the special education instruction, supports, and services a student needs.





Legal

The justice system is the set of courts and processes that handle legal cases, decide if laws were broken, and determine the consequences.



Availability
Please provide preferred days and times you'd like to meet:

Ex: Day: Tuesday                                                        Ex: Times: 10:00 am-12:00 pm    




Media Release
I hereby grant Hmong American Partnership (HAP) permission to use my name, image, voice, and/or statements for promotional and publicity purposes, without compensation. I understand that I may be photographed, recorded on video and/or audio, and/or quoted. I release HAP, its staff, and associates from any and all claims, actions, and  liabilities that may arise in connection with the use of these materials. I also waive the right to review or approve the material before its use.

Participant Acknowledgement, Release and Waiver of HAP Liability
I understand that HAP may check public records to view my criminal background record. 

All personal identification data is private and used to determine program eligibility, for grant reporting purposes and to increaser our services to participants. It will not be unnecessarily accessed, reviewed or disclosed. 

By participating in Hmong American Partnership (HAP) programs, you acknowledge and agree to use services and resources according to all laws, rules, grant agreements, and communications by HAP staff regarding the proper uses of services and resources.  You further acknowledge and agree that HAP is not responsible for misuse or exploitation of services or resources provided to you.  You further release HAP from liability and waive your right to sue HAP.

By signing and submitting this form, you confirm your understanding that HAP will not be liable for any actions or outcomes arising from your participation in HAP programs.


After clicking '"submit," you will be taken to the signature page. Once you’ve completed your signature, a notification email will be sent to the address you provided in your application. To finalize your response, please confirm receipt of the verification email by clicking the URL link sent from no-reply@formassembly.com. If you don’t see the email in your inbox, please check your junk folder.
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Contact Information