Enroll in PartnerUp – West Virginia Women Work

Name *

First

Last

What is your preferred name/nickname?

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

Please share your pronouns

She/Her/Hers
He/Him/His
They/Them/Theirs
Other Not Listed (please list below)

Pronouns other

Are you currently a student or alumni of Step Up for Women Construction or Advanced Manufacturing? *

Yes
No
Applied previously but have not attended the program yet

Where did you learn about the PartnerUp program? *

Flyer
Trifold/Brochure
Social Media
During the interview for one of the Step Up for Women training programs
Current Step Up for Women student
Step Up for Women Alumni
Referred by someone (please let us know who)
In-person event (please list which event)
West Virginia Women Work Website

We want to make sure we are reaching everyone and using our marketing efforts to our best ability. Please let us know how you heard about the program.

Who referred you to PartnerUp? *

Which in-person event did you learn about PartnerUp? *

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth *

Current Household Income? *

0 - 10000
10000 - 25000
25000 - 50000
50000 +

How do you prefer communication between you and your mentor? *

What is your highest level of education? *

High School Diploma
Some College
College Degree
Other

Highest level of education other *

What barriers do you need help addressing? *

List any other barriers you are currently facing. *

What are your current goals? *

Other Goals Not Listed Above *

Is there anything else you would like us to know about you?

Please indicate how you identify yourself: *

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

Do you consider yourself part of the LGBTQIA+ community? *

Yes
No
Prefer not to answer