First Name *

Last Name *

Phone Number *

Your Email *

Birthdate (mm/dd/yyyy) *

What city do you live in? *

Are you currently employed? * —Please choose an option—YesNo

If you are currently employed, do you work less than 20hrs per week? * —Please choose an option—YesNo

Are you currently enrolled in school? * —Please choose an option—YesNo

Are you legally permitted to work in Canada? * —Please choose an option—YesNo

If so, what is your status? * —Please choose an option—Canadian CitizenPermanent ResidentRefugeeWork PermitStudent PermitOther

How are your computer skills? * —Please choose an option—I could use some helpFairGood

Do you have a laptop or computer with microphone and camera capabilities? * —Please choose an option—YesNo

When are you most likely to be available* —Please choose an option—MorningAfternoonEither works

Can you commit to 2-3 hours a day of in-person or virtual class work? * —Please choose an option—YesNo

What industry are you interested in? * —Please choose an option—SecuritySocial ServicesHospitality &TourismLabourOffice AdministrationFitnessOther *

* If Other selected above, fill in this field.

Which program are you interested in? * —Please choose an option—Multi-barriered (Kamloops)Rise Program for Survivors of Violence and/or Abuse (Kamloops)Youth (Kamloops)Multi-barriered (Sechelt)

Do you identify as having a disability or long-term health issue? * —Please choose an option—YesNoI'm not sure

Where did you hear about this program? *
FacebookInstagramOnline Search (e.g. Google)Info Booth (e.g. at Starbucks)Radio / TVNewspaperWorkBCBrochure / PosterJob FairOther: