GSI Enrollment Application Survey

1.Are you a Pierce County Resident?(Required.)

Yes

No

2.Are you between 18- 26 years old?(Required.)

Yes

No

3.Are you eligible to work in the U.S.?(Required.)

Yes

No

4.Personal Details(Required.)

First Name

Last Name:

Middle Name:

Age:

Date of Brith:

Race/ Ethnicity

Email:

Phone:

5.Emergency Contact:(Required.)

First and Last Name:

Phone Number:

Relationship to you:

6.First day of class is on the September 16th at 8:00 AM at Clover Park Technical College in Lakewood, WA. Is there anything that could be an issue to get there on time? If Yes, include below in the text box.

7.How did you hear about us?