Skillbridge Application

Application

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12 Characters
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Personal Information

Assigned IDs (For Testing Purpose Only)

Eligibility Entry/Token ID

This is the entry/token ID ported over from GF Eligibility. Record this ID during testing if the outcome was not as expected with a description of the issue.

SF Application ID

https://help.formassembly.com/help/344494-object-alias

First Name

Last Name

Email Address

Cell Phone Number

Street Address

City

State

Zip Code

County

Date of Birth

MM/DD/YYYY

Age

Emergency Contact Information

Name

Relationship

Phone Number

Identification

Attach a photo of your Driver's License or Picture/Military ID.

Attach ID File

Self-Reporting

NPower invites all applicants to voluntarily report their race, gender, ethnicity and preferred pronouns. Your responses are collected for internal data collection purposes and will not be used to determine program eligibility.

Race/Ethnicity

Please Specify

Do you identify as Hispanic/Latinx?

YesNo

With which gender identity to you most/currently identify?

Previous Experience

Educational Experience

What is the highest level of school or completed degree?

Name of Course

College/Education Program

Have you ever enrolled in a college or post-high school education program?

YesNo

Are you currently enrolled in a college or an education program?

YesNo

Name of College/Program

Degree/Program Topic

Were you enrolled full-time or part-time?

Are you enrolled full-time or part-time?

Graduation or Completion Date

MM/DD/YYYY

Projected Graduation or Completion Date

MM/DD/YYYY

When did you last attend?

MM/DD/YYYY

Please provide further details.

Projected Graduation or Completion Date

MM/DD/YYYY

Technology Experience

Have you taken any technology classes?

YesNo

Name of Institution

Name of Class

Do you have any technology certifications?

YesNo

Please select any technology certifications that you have.

A+ Certified	CCENT	CCNA	ITIL
Linux	MCA	MCP	MCSE
MCT	MOUS	Network+	Security+
IT Fundamentals	None	Other

Other

Please select all technology programs in which you have proficiency:

Microsoft Office Solutions WordExcelOutlookPowerpointAccess	Operating Systems Mac OSWindowsLinuxUnixAccess	Web Development HTMLJavascriptFlashCSS
Networks ServersRoutersHubsSwitchesEthernet Cables	Desktop Publishing PhotoshopMS Publishing

Have you had to communicate technical information (written or verbal) to people less tech-savvy than yourself? If yes, please describe below. If no, please enter "No" below.

Income

Are you head of household?

YesNoA person is considered HoH if they are primarily responsible for financially supporting the other members of the household.

What is your current marital status?

Household size:

Annual Individual Base Pay:

Yearly income from all sources for applicant only. Example: 30000

Military Status

Separation or estimated separation date?

MM/DD/YYYY

Branch of Military Service:

Air Force Rank

Navy Rank

Army Rank

Marine Corps Rank

Coast Guard Rank

Military Installation

Type of Discharge

Have you served in a combat/war zone?

Are you registered at the VA?

Era(s) of Service

Iraq/Afghanistan (9/11/2001 - Present)	Gulf War I (8/1990 - 9/10/2001
Post-Vietnam (1976 - 7/31/1990)	Vietnam (1964 - 1975)
Post Korean (1956 - 1963)	Korean (1950 - 1955)
Post WWII (1946 - 1949)	WWII (1941 - 1945)
Other

Select security clearance

Specify your security clearance.

Please identify your military specialty below (MOS, AFSC, NEC)

Please describe your Military Specialty below.

Please identify any significant honors, awards, decorations.

Immediate Commanding Officer

Name & Rank

Phone Number

Career Counselor

Name

Phone Number

SkillBridge Counselor

Name

Phone Number

Program Interest

You’re almost finished! Now, we’d love to hear directly from you. Please respond to ALL of the questions below. (Each response requires a minimum of 150 words per question.)

Why are you interested in participating in our NPower SkillBridge program?

Please write 3-5 sentences.

Resume

Attach a copy of your resume as either a Word or PDF document. If resume not readily available, contact Admissions for your region; contact information located on www.NPower.org.

Attach File

Please make sure that you have completed all required fields before hitting the Submit Application button. Only your first application for this cohort will be considered.

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