SUFWC Application – West Virginia Women Work

Where did you learn about Step Up for Women? *

If you selected "Other", please specify: *

If you selected "In Person Event", please specify: *

If you were referred by a previous graduate, what is their name? *

Step Up site closest to you: *

These locations are both in West Virginia

Name *

First

Last

What is your preferred name/nickname?

If you go by a name other than your given name please tell us here

Date of Birth *

What are the last 4 digits of your social security number? *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

What county do you currently live in? *

Example: Kanawha, Lincoln, Putnam, Clay, Monongalia

Phone Number *

Cell Phone

Do you currently have a driver's license? *

Yes
No
Yes, but it's suspended

Do you own a car and is it available for personal use? *

Yes
No

If no car, how do you plan on getting to class/work? *

Are you currently married or in a relationship?

Do you have dependents? *

Yes
No

How many dependents do you have? *

Number of people in household? *

Are you willing and able to obtain full time employment at the conclusion of training? *

Yes
No (please explain below)

Explain why you are not able to obtain full time employment at the conclusion of training *

Do you currently or are you scheduled to receive Unemployment Compensation? *

Yes
No

If yes, when will your UC benefits end? *

Check any that apply to you: *

*A displaced homemaker is someone who has spent most of their time taking care of their family without pay (like a stay-at-home parent) and is now out of work or working a low-paying job, and having trouble finding a better job.

Check any forms of assistance you currently receive: *

Current Estimated Yearly Household Income: *

0 - 10000
10000 - 25000
25000 - 50000
50000 +

Are there any adjustments or supports we should know about to make sure you can participate fully in training and job placement? *

Yes
No

If yes, please explain: *

Have you ever been convicted of a felony? (Your answer will not impact the outcome of your application) *

Yes
No

What were the charges? *

Did your conviction result in incarceration? *

Yes
No

Have you ever been convicted of a misdemeanor? (Your answer will not impact the outcome of your application) *

Yes
No

What were you charged with? *

If on parole/probation can we speak to your parole/probation officer? *

Yes
No

If yes, be sure to provide name and number during your interview

Why are you interested in enrolling in the Step Up For Women training program? *

Do you have your High School Diploma or GED? *

Highschool Diploma
GED
No

If no, highest grade completed? *

If no, are you interested in obtaining your GED?

Yes
No

Check any of the following Math levels completed while in school:

What other math levels have you completed?

List all vocational technical courses completed:

Include course title, year completed, and school.

Have you taken any courses since high school?

Yes
No

List all degrees and certificates, year received, and school:

Current Employment Status: *

Employed full time
Employed part time
Unemployed
Student

If currently employed what is your hourly wage? *

What do you make an hour? Example $10.00

Employment history: Include title and wages for the past five years *

List most recent jobs first.

Any additional information you would like us to know:

Provide any other information that you feel makes you a good candidate to participate in the Step Up for Women training program.

Do you have reliable access to a computer you can use for class? *

Yes
No

Don't worry if you do not, we have laptops we can loan to use for class.

Do you have reliable access to the internet for class? *

Yes
No

Don't worry if you do not have internet access. We can make arrangements for you to use the internet at a local library or on Fridays at our office.

Please indicate how you identify yourself: (We will use this data for grant reporting. All data will remain anonymous and will only be used for this purpose.) *

American Indian or Alaska Native (including all Original Peoples of the Americas)
Asian (including Indian subcontinent and Philippines)
Black or African American, not Hispanic (including Africa and the Caribbean)
Native Hawaiian or Other Pacific Islander (Original Peoples)
White, not Hispanic (including Middle Eastern)
Hispanic or Latino
Two or More Races (not Hispanic or Latino)
Other
Prefer not to answer

By submitting this form, I give West Virginia Women Work and its staff permission to contact me by email, phone, or text message regarding my application and program participation. Standard message and data rates may apply. I can opt out at any time.

I understand that Step Up for Women Construction is a 12-week pre-apprenticeship program that provides introductory instruction only, including career exploration, soft skills training, and basic hands-on exposure to carpentry, plumbing, electrical, and other tasks as available. *

I understand

I understand this program is designed to help me build the basic skills and confidence needed for an entry-level job in the trades or to apply for an apprenticeship or on-the-job training program. It is not designed to make me a skilled tradesperson or licensed professional. *

I understand

I understand that completing this program does not guarantee employment, acceptance into a registered apprenticeship program, or placement with any employer, union, or training provider. *

I understand