Quickstart Program Inquiry Begin your Quickstart application process here.Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict 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 Are 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 Job Placement 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 program.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?TransportationChild CareConflict with Work SchedulePurchase of Steel Toe BootsPersonal Support System (friends, family, etc)Health ConcernsMath or English (listening, speaking, reading, or writing)NoneOtherIf other, please explain briefly.AcknowledgementBy 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. If you have any questions you may contact Mary Powers at 409-944-1287 or mpowers@gc.edu Se habla español.PhoneSubmit
