2018-2019 Women's Economic Empowerment Programming Application Application Form for all 2018-2019 Programs Question Title * 1. Personal Information Name Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 2. What is your date of birth? Date / Time Question Title * 3. What is your residency? Canadian Citizen Permanent Resident Have lived on PEI the past 3 months All of the above Question Title * 4. Do you currently have an Employment Assistance Services worker? (i.e CDS, CMHA, PEI CoD, PEI ANC, MCPEI, etc) Yes No Not sure If yes, who is the worker? Question Title * 5. Financial Information - Please select all that apply to you Employment Insurance Regular Benefits (current or in the past 3 years) Employment Insurance Maternity Benefits (current or in the past 5 years) Employment Insurance Sick Benefits (current) Income Support No current income Awaiting Employment Insurance Claim Working less than 20 hours/wk Taking training Other (please specify) Question Title * 6. Education- Please select all that apply High School Graduate (including GED) College Additional Training Other If you answered College or Additional Training, what course(s) did you attend? Question Title * 7. What kind of paid work have you done in the past 5 years? Question Title * 8. Do you have any volunteer experience? Question Title * 9. How do you spend your spare time? Question Title * 10. What's important to you? Question Title * 11. What do you want us to know about you? Question Title * 12. Why are you applying for programming at this time in your life? Question Title * 13. Please tell us one long term and one short term goal you have Question Title * 14. What motivates you (to make change in your life)? Question Title * 15. Is there a job or area of work that you are interested in exploring? If yes, please tell us why it appeals to you. Question Title * 16. If needed, are you willing to upgrade your education to achieve your career goals? (eg. GED, Adult Education courses such as English, Math, Sciences etc) Yes No Not Sure Comment Question Title * 17. Are you able to commit full-time to (Monday-Friday) to programming? The attendance expectation for our program is that participants commit to a 8:30am-4:30pm schedule from Monday-Friday for 12 weeks. A minimum attendance rate of 85% is needed to complete the program. Yes No Maybe Question Title * 18. What things may prevent you from fully participating in all program days & activities? Access to regular and reliable travel arrangements My health Access to regular and reliable childcare Other (please comment below) Comments Question Title * 19. Which program are you applying for? Propelle (September 17 - December 7, 2018) Trade HERizons (January to March 2019) Either program Question Title * 20. What is the best way to reach you? (please select all that apply) Phone call Text message Email Leave a voicemail Other (please specify) Question Title * 21. How did you learn about the program? Thank you for your application. We will be in touch with you shortly Complete!