SCOSA 2015 Mailing List and Event Registration Form Question Title This form is no longer active. Please copy and paste this address into your browser window for a redirect to the 2016 contact form. https://www.surveymonkey.com/s/SCOSA2016 Question Title * 1. Contact Information First Name Last Name Street Address City State Zip Phone (starting with area code) e-mail address If employed provide title and organization. Question Title * 2. Please indicate your reason(s) for completing this form today: (check all that apply) I wish to be added to the SCOSA mailing list and receive periodic print and e-mail updates/announcements. I am writing to correct or add to my contact information that SCOSA has on file. I wish to register for specific upcoming programs. Remember to select each program, from the list below, for which you wish to register and add the names of all registrants. Other, please specify Question Title * 3. Please include names of all people registering for each event and you will be contacted with a confirmation email. If you do not add the names of those you want to register they will not be registered. Note that some of the workshops meet multiple times. When you register, we hope you are making a commitment to attend all meetings to complete your training in that course. SCOSA has lots of other programs that are not listed here because they do not require preregistration. Please see our Calendar of Events page on the SCOSA website for a complete listing. Waiting List for next session of Find, Get and Keep the Job You Want. You will be contacted with details when they are availalble. Question Title * 4. Please enter any questions you might have. Question Title * 5. Our Older Adult Education offerings are free unless otherwise noted. We are partially funded under the Older Americans Act of 1965, as amended. Federal law mandates that we accept donations for services provided. Any donation received will be used for future services. Your answers to the following questions are not mandatory, however, they help us determine eligibility for program funding. Your answers will be strictly confidential. Age Question Title * 6. Annual Earnings Annual earnings under $10,890 (one person) or $14,710 (two people) Annual earnings over $10,890 (one person) or $14,710 (two people) Question Title * 7. Race and Ethnicity American Indian / Alaskan Asian Black / African American Hispanic / Latino Native Hawaiian / Pacific Islander White / Non- Hispanic White / Hispanic Other Race Two or More Races Click here to SUBMIT your information