SUR Intake Form - West Virginia Women Work

Please fill out the form below so that we are able to match you with the right programs/services.

Name *

First

Last

Email *

Phone *

What county do you reside in? *

Monongalia, Marion, Harrison, etc.

Are you 18 years or older? *

Yes
No

more Are Have

What kind of career are you interested in? *

I want to learn more about the following: *

Future hands-on bootcamps
Virtual skilled trades training
Industry certifications (OSHA 10, First Aid/CPR, and more)
Career coaching/mentoring
Job opportunities in the trades
Step Up for Women Construction Pre-apprenticeship Training

These questions help us understand who we are serving and report overall program impact to our funders. Your responses help us continue offering trainings like this at no cost.

Have you, your family, or your community been impacted by substance use or recovery? *

Yes
No
Prefer not to answer

Have you or someone in your family ever been involved with the court system — for example, an arrest, criminal charge, or time in jail, prison, or juvenile detention? *

Yes
No
Prefer not to answer