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Cohort Interest Form
Cohort Interest Form
The first step to reimagining your career.
First Name
Last Name
Street Address
City
State
Zip Code
Phone
Email Address
How did you hear about Advance Louisville?
Are you eligible to work in the U.S.?
Yes
No
Do you have a GED or High School Diploma?
Yes
No
Do you currently receive or are you currently applying for Supplemental Security Income (SSI) and/or Social Security Disability insurance (SSDI) benefits?
Yes, currently receiving benefits
Yes, applying for benefits
No
Are you the primary caregiver of a child 0-13 years old?
Yes
No
Are you currently experiencing homelessness?
Yes
No
Are you within 1 hour of South Louisville?
Yes
No
Do you have an open legal case that could result in any interference with attendance to our six month program?
Yes
No
Are you applying at the same time as a spouse, parent, sibling or child?
Yes
No
Our program is designed to help you land a full-time career. Are you willing and able to work full-time after completing our program in your new career?
Yes
No
What types of government assistance do you receive?
None
SSDI
SSI
TANF
Child Care Assistance
Unemployment
SNAP
Medicaid
Section 8
Other
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