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Manhood University – Class of 2021
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1.
Email Address
(Required.)
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2.
First Name
(Required.)
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3.
Last Name
(Required.)
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4.
Main Phone Number
(Required.)
5.
Alternate Phone number
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6.
Address: (street number/name/ Apt#, city, state and zip code)
(Required.)
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7.
Date of Birth
(Required.)
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8.
Are you currently employed?
(Required.)
Yes
No
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9.
Have you ever been convicted of a misdemeanor or felony?
(Required.)
Yes
No
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10.
Are you currently on Probation or Parole?
(Required.)
Yes
No
11.
Please select your highest level of education completed:
11th grade or less
High School Diploma, GED or HiSet
1 year of college
Associates Degree
Bachelor's Degree
12.
Are you interested in further education?
Yes
No
13.
Select all that apply:
Recipient of SNAP (Supplemental Nutrition Assistance Program) or living in a home with a recipient of SNAP
Recipient of TANF (Temporary Assistance for Needy Families) or living in a home with a recipient of TANF
Recipient of SSI/SSDI (Supplemental Nutrition Assistance Pro) or living in a home with a recipient of SSI/SSDI
Individual with a Disability
A homeless Individual
A Veteran or spouse of a veteran
Parenting or expecting a child
Need Transportation Assistance
None of the above
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14.
Do you plan to attend in the morning or afternoon?
(Required.)
Morning
Afternoon
15.
What is your t-shirt size?
S
M
L
XL
XXL
Current Progress,
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