Corporate Group Application

Group Application

Please fill in this form to determine your eligibility for the class. Someone will contact you to confirm your enrollment in the class. * Indicates required fields.

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Course Information

*Registration Code

Course Applying For

Hosting Campus

Course ID Course Number Course Section

Schedule

Prerequisites

Personal Information

*Legal First Name

Preferred Name (if different from Legal First Name)

*Legal Last Name

*Gender

* Date of Birth (for verification purposes only)

Are you Hispanic or Latino?

Yes No

Contact Information

*Email Address (all communication will be sent via email)

*Confirm Email Address

* Cell or Other Primary Phone Number ( ) —

By listing a cell phone number, a UH staff member may communicate with you through texting. Standard text message and data rates may apply.

Residential Address (Hawaii address required)

*Street Address and Unit Number, if applicable

*City

State

*Zip Code

*Island

Education

*Highest level of education attended and completed

Area of study for highest level of education

* Did you recently graduate?

Name of school

UH username (if current or former UH student) - you may check your UH username here

UH may be able to assist in covering the cost of the training. Based on information that you provide below, you may be eligible for financial assistance.

*Citizenship

* Due to COVID (during the pandemic or through to present day), I or someone in my household had or has
Please note: if you indicate Not Applicable, you may not be eligible for funding for some Oahu resident programs due to grant requirements. You may select a response for impact to any household member or yourself to be eligible for funding at any point during or after the pandemic.

Current Employment Status

* Select employment status

* Are you employed in your field of study that you are seeking additional training? (required if currently working and recent college graduate)

* Your current employer

* Do you earn $20 or more per hour?

* Why do you want to take this training? (select one or more of the following)

*What is your immediate employment goal after completing this training? In terms of your job and education, where do you want to be in five years? (maximum 1,000 characters)

Additional Support Services - please complete this section to determine if you are eligible for additional support services and financial assistance

Marital Status

Household size (as claimed on your last tax return)

Annual income (as claimed on your last tax return)

Are you receiving Supplemental Nutrition Assistance Program (SNAP) benefits for food?

Do any of these military affiliations apply to you?

*Do you have a computer or tablet (e.g. desktop, laptop, iPad)?

*Do you have internet access?

How did you hear about this training opportunity?

Verification

By submitting this application, I certify the following:

- The above statements are true to the best of my knowledge.

- UHCC may contact me to verify my Hawaiʻi residence and experience of hardship due to the COVID-19 pandemic. I may be asked to verify the information with documentation such as:

Hawaiʻi Driver's License, State ID or billing notice to current address.

- I will participate in a follow-up survey 3 to 6 months after course completion as continued funding for Good Jobs Hawaii requires reporting on student outcomes.

* I give my consent to UH Community Colleges to provide my application information to another appropriate agency or partner for support services.