Grundy Questionnaire

Free Career Training

Fill out our form to see if you qualify for our free career training via Grundy Workforce Services.
Training in the following areas is provided:
- Healthcare
- Information Technology
- Construction
- Automotive
- Welding
- Business

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Please complete the questions.

Responses determine eligible funding sources and will not disqualify anyone from applying for the training scholarship.

First Name

Last Name

Email Address

Phone Number

Zip Code

Do you have a High School Diploma or GED?

Yes

Are you Authorized to work in the US?

Yes

Date of Birth

Are you under 25 years of age?

Yes

Please enter your full Mailing Address

Are you a Parent or Pregnant?

Yes

Do you have a Felony or Misdemeanor?

Yes

Do you have a Documented Disability?

Yes

Are you in or have been in Foster Care?

Yes

Are you Employed?

Yes

Are you Receiving UI (Now or in the past)

Yes

Have you Received Food Stamps? (Now or in the past 6 months)

Yes

Hispanic/Latino

Yes

Race/Ethnicity

American Indian

Black

Prefer Not To Answer

Asian

Hawaiian or Pacific Island

White

How did you hear about us?

Facebook

Web site

Other…

How Would you like us to follow up with you?

Phone Call

Text Message