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Scholarship Form

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Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Telephone #: *

Email *

How did you hear about us? *

Primary Language *

English
Spanish
Both

*Our courses are offered in English and Spanish.

Which one best describes your situation? *

I was injured on the job.
I am receiving financial assistance from Welfare or Temporary Assistance for Needy Families (TANF).
In the past 12 months, I have worked in agricultural related fields.
I am a Veteran.
I am employed.
I receive unemployment benefits.
I am receiving Supplemental Security Income (SSI) or (SSDI).
I have received unemployment with the past 12 months.
I am receiving Supplemental Nutrition Assistance Program (SNAP or food stamps).
I am unemployed at the moment.

CDI is partners with the companies listed below that offer scholarships for career training. Do you participate with any of the following companies?

Local WIOA Employment Connection
JTO
Proteus
Department of Rehabilitation
VA Education Benefits
Workman's Comp

What type of training are you focused on? *

Update my skills
Career change
Advance your career
Learn new skills

I'd prefer to do my training:

In-class
Online

I'd like training in:

Office Automation (Office Environment)
Microsoft Excel (Beginner - Advanced)
Building Maintenance (Building Trades and Maintenance Field)
Computer Repair Technician (Computer building and repair)
Microsoft Word (Beginner - Advanced)
Front Office Medical Assistant (Front office in the medical field)
Customer Service Technician

How willing and able are you to invest in your training right now? *

I have the financial resources and I am willing to invest in my training right now.
I have access to financial resources and I am willing to invest in my training right now.
I have no financial resources and I am unwilling to invest in my training right now.

Please tell us about your goals and what you hope to achieve for your future. *

If accepted into one of our trainings, please tell us when would you like to begin? *

Career Development Institute (CDI) values your privacy. By clicking submit below, I agree that Career Development Institute may contact me by phone, text and/or email at the phone number and email address provided above, including a wireless number. Your information will only be used by CDI. We will not sell your information to any other party.

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