Assistance Application
Name:
*
First Name
Last Name
Birth Date
Please select a month
January
February
March
April
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June
July
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Month
Please select a day
1
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Day
Please select a year
2024
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1920
Year
Phone Number:
*
-
Area Code
Phone Number
E-mail Address:
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What do you need assistance with?
*
Transportation
Academic Tutoring
Employment Skills
Computer or Laptop
English Second Lang
Money for Food/Living
Other (please specify)
Mentor / Counselor
Type of Counseling Needed
What type of career counseling do you need?
Finance
Fitness / Health
Graphic Design
Healthcare
HR/Recruiting
International Job Seekers
Media
Mid Career
New Managers
Non-Profit
Public Relations
Public Speaking/Interviewing
Relocating
Remote Job Seekers
Returning to Workforce
Startups
Veterans
Visa/Sponsorship
Women
Educational System
High School
Graduation Date
-
Month
-
Day
Year
Date Picker Icon
College (if any, if none, write "none")
Extracurricular Activities
*
Please list any activities you participate in and your roles and responsibilities.
Describe one specific example of your leadership.
I am a (Check one)
U.S. citizen
U.S. national
Resident alien expecting citizenship by the date of award
Essay Questions
List awards, scholarships, publications or special recognitions you have received. List in descending order of significance.
What are the three most significant courses you have taken in preparation for your career? Briefly explain why these courses were most significant.
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