Girls For Technology/GalaxE Solutions Service desk trainee program Application Form 2022 Cohort 3

1. Personal Information

Question Title

* 1. Applicant Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Date of Birth

MM/DD/YYYY

Date

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* 3. Do you identify as one of the following ?

African American or Black

Asian or Asian American

American Indian or Alaska Native

Hispanic or Latino

Native Hawaiian or other Pacific Islander

White or Caucasian

Other (please specify)

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* 4. Gender ?

Male

Female

Transgender

Prefer not to answer

Prefer to self-identify

Other (please specify)

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* 5. How did you hear about this program?

Girls For Technology

Community Centers

Church

Library

Social Media

School

CWP/American Job Center

211

Other Sources (if referred, please specify name)

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* 6. Is English your first language ?

Yes

Other (please specify)

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* 7. Are you legally permitted to work in the United States?

Yes

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* 8. Have you ever been arrested or convicted of a crime in the past 5 yrs?

Yes