ZICT TRAINING PROGRAM REGISTRATION FORM - Scholarship Opportunity

Full Name *

Email *

Phone *

Street Address *

Age *

County

Select an option

Employment Status

Employed

Unemployed

Underemployed

Other

Please Specify

Current Income Bracket($) *

Select an option

Highest Level Of Eduation *

Select an option

Do you have a High School Diploma? *

Yes

No

Best Time to Contact You *

Choose one or more options

Select Program *

Select an option

Years Of IT Experience *

Select an option

Reason For Change of Career

Interested in Our Technical Career Development and mentorship Program

Yes

No

PAYMENT TYPE *

Select an option

Workforce Center Payment (ETPL Questions)

Have Connecting Colorado (Required for WIOA Approval)

Yes

No

Do you have children in middle or high school?

High School

Middle School

Both

None

Referral Information: Please provide the name of the person who referred you, if applicable.

How did you hear about us? *

I commit to completing all necessary registration requirements and fulfilling payment obligations as outlined. If admitted into the training program, I agree to follow through with all associated responsibilities. ZICT, in turn, commits to delivering all the packages and services included in the training program.

Privacy Policy | Terms of Service