Quickstart+ Program Inquiry Please enable JavaScript in your browser to complete this form.Begin your Quickstart+ application process here.Name *FirstLastAddress *Address Line 1Address Line 2CityTexasAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneEmail *Gender (required) *MaleFemaleDate of Birth (MONTH/DAY/YEAR) (REQUIRED) *!! NOTE: YOUR BIRTHDATE IS REQUIRED !!Current Age (REQUIRED) *!! NOTE: YOUR AGE IS REQUIRED !!Select 1 Program Interest (required) *Electrical HelperHVAC HelperWhat is the highest grade level you completed? *Elementary School (Grades 1-5)Middle School (Grades 6-8)9th Grade10th Grade11th Grade12th GradeHigh School DiplomaGEDSome college/training after high school completion/GED (previous certificates)Associates Degree or HigherDegree outside the United StatesPrimary Language Spoken at Home (If you are proficient in more than one language, please choose the one language most often used.) *EnglishSpanishOtherAre you a citizen of the United States or certified to work in the United States? (required) *YesNoYou must bring in a Social Security card or original I-9 documents to meeting with Grant Navigator upon acceptance into program.Are you registered with the U. S. Military Selective Service, required of all males? (required) *YesNoYou may be required to present your Registration Acknowledgment Card upon acceptance into the program. *The grant navigator can help you with this during your intake.Are you a U. S. Veteran? (required) *YesNoAre you currently employed? (required) *YesNoGoals Statement Please write a short paragraph telling us why you want to be given this opportunity and what you hope to gain from it. Expand on why you think you would be a good candidate for this program.Goals Statement *What obstacles, if any, do you see as a barrier to your regular attendance and completion of the program? *TransportationInternet Access or Computer accessChild CareConflict with Work SchedulePurchase of Steel Toe BootsPersonal Support System (friends, family, etc)Health ConcernsMath SkillsEnglish SkillsListeningSpeakingReadingWritingNoneOtherIf other, please explain briefly.Acknowledgement *I agreeBy submitting this interest form, I understand that I will be contacted by a representative of Galveston College for an Intake Interview via phone and/or in person. Completion of this form does not necessarily mean that I am accepted into the Quickstart+ Electrical or HVAC Helper Program. EmailSubmit
