United Way Miami Workforce Project Application

First Name

Middle Name

Last Name

Email

City

State

-- Choose a State --ALABAMAALASKAARIZONAARKANSASARMED FORCES EUROPEARMED FORCES PACIFICCALIFORNIACOLORADOCONNECTICUTDELAWAREDISTRICT OF COLUMBIAFEDERATED STATES OF MICRONESIAFLORIDAGEORGIAGUAMHAWAIIIDAHOILLINOISINDIANAIOWAKANSASKENTUCKYLOUISIANAMAINEMARYLANDMASSACHUSETTSMICHIGANMINNESOTAMISSISSIPPIMISSOURIMONTANANEBRASKANEVADANEW HAMPSHIRENEW JERSEYNEW MEXICONEW YORKNORTH CAROLINANORTH DAKOTANORTHERN MARIANA ISLANDSOHIOOKLAHOMAOREGONPENNSYLVANIAPUERTO RICORHODE ISLANDSOUTH CAROLINASOUTH DAKOTATENNESSEETEXASUTAHVERMONTVIRGIN ISLANDSVIRGINIAWASHINGTONWEST VIRGINIAWISCONSINWYOMING

ZIP Code

Phone

Date of Birth

Gender

-- Choose One --MaleFemaleNon-binaryOtherDon't want to provide an answer

Race (select all that apply)

Native Hawaiian or Other Pacific Islander

Middle Eastern or North African

Hispanic, Latinx, or Spanish

South Asian or Indian American

American Indian or Alaskan Native

White

East Asian or Asian American

Black or African American

Other

Prefer not to answer

Other (please specify):

Veteran Status

-- Choose One --NoneActiveVeteran

What's your highest level of education completed?

-- Choose One --Less than high school completionCompleted high school or GED certificateSome college - Not completedCompleted vocational/trade programAssociate’s degreeBachelor’s degree or higherPrefer not to answer

Do you receive any of the following public assistance benefits? SNAP, TANF, SSI, Medicaid, Housing Choice, Voucher Program (Section 8), WIC, and/or EITC.

-- Choose One --YesNoI don't know

Total earnings from employment before taxes in the 12 months before enrolling.

$

.00

Please share your job experience over the past 12 months (industry, job title, etc.)

If you were not employed over the past 12 months, please write "Unemployed"

Number of children aged 0-3 in household

Number of children aged 4-17 in household

Number of adults in the household

How did you hear about this program? (Select all that apply)

United Way Miami

Barry University

Newspaper

Online search

LinkedIn

Other social media (Facebook, Twitter, Instagram etc.)

Friends/family

Other

Other (please specify):

By participating in this program, you consent to having your data shared among the Miami Workforce Project partners (Barry University, United Way Miami, and Social Finance Inc.) for program coordination purposes. Staff follow strict rules to protect your data. Your name and any other personally identifiable data will never be presented in any published reports. Do you consent to the terms above?

-- Choose One --YesNo

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