Skip to content
Give $25
About
Our Mission & Why It Matters
Our History
Meet The Team
Alumni Success Stories
In The News
Training & Workforce Support
In-Person Training
Step Up Construction
Virtual Job-Readiness
SkillUp
Mentoring & Career Support
PartnerUp Mentoring Program
For Employers
Workforce Solutions
Ways to Support
Partner With Us
Employment & Volunteer Opportunities
Sponsor A Scholarship
Donate
Info & Tools
Apprenticeships & Jobs
WVDOT OJT Program
Resource Center
Blog
Publications
Industry Chatter
FAQ
25 YEARS OF IMPACT
Contact Us
Accessible Contact Options
West Virginia Women Work Media Kit
About
Our Mission & Why It Matters
Our History
Meet The Team
Alumni Success Stories
In The News
Training & Workforce Support
In-Person Training
Step Up Construction
Virtual Job-Readiness
SkillUp
Mentoring & Career Support
PartnerUp Mentoring Program
For Employers
Workforce Solutions
Ways to Support
Partner With Us
Employment & Volunteer Opportunities
Sponsor A Scholarship
Donate
Info & Tools
Apprenticeships & Jobs
WVDOT OJT Program
Resource Center
Blog
Publications
Industry Chatter
FAQ
25 YEARS OF IMPACT
Contact Us
Accessible Contact Options
West Virginia Women Work Media Kit
Please enable JavaScript in your browser to complete this form.
apply) deactivated the
Name
*
First
Last
Email
*
Phone
*
City
*
State
*
County
*
Which organization referred you to our program?
*
Why We Ask This
Some of the information on this form is collected to meet reporting requirements for our grants and funders. Your responses help us continue offering programs like this at no cost to participants. All information is kept confidential and will not be used for any other purpose or shared outside of required grant reporting.
Age Range
*
18 - 24
25 - 34
35 - 44
45+
Current Income Level
*
0 - 9999
10000 -24999
25000 - 49999
50000+
Do you currently receive any of the following?
*
SNAP
WIC
WV Works/TANF
SSI
SSDI
HUD/Section 8/Housing Assistance
Medicaid
Childcare Assistance
None of the above
Select all that apply
Do any of these apply?
*
Single parent
Head of household
Displaced homemaker
Veteran
None of the above
*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.
Number of people in household?
*
Do you consider yourself part of a group that’s been impacted by the justice system (for example, through past incarceration, probation, or related experience)?
*
Yes
No
What is your race/ethnicity? (Select all that apply)
*
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Two or More Races
Other (please specify)
Prefer not to answer
Other race/ethnicity?
*
Gender
*
Male
Female
Prefer not to answer
Please note: Interplay Learning seats are limited. Accounts that show no activity for two weeks will be deactivated so we can offer the seat to another participant.
*
I Understand that if my account shows no activity for two weeks, my seat will be deactivated and given to another participant.
Submit
