PepUp Tech Academy Virtual Course May 2023

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Course Selection

Thank you for your interest in PepUp Tech. Before starting your application make sure you collect the following documents:

Statement of Interest (one paragraph essay explaining why you think this program is a good fit for you)
Resume (include references)
Proof of Income (W2's. Paystub, tax return, Pell eligibility, other)
NOTE: If you are already approved through CareerSource upload your eligibility letter instead of your Financial documentation
If you hold any Salesforce certifications you are not eligible for this course

It is helpful to collect the required documents prior to starting your application. If you have any questions or comments, please email admissions@pepuptech.org.

We are excited to support you along your journey.

Course Schedule:
Class Start/End: 5/22/2023 - 7/26/2023
Days and Times
Mandatory: Monday: 6:30pm - 8:30 pm
Mandatory: Wednesday: 6:30pm - 8:30 pm
Optional: Saturdays: 9am - 11am

Personal Information

First Name

Last Name

Date of Birth

Gender

Email Address

Phone

Ethnicity

Address Line 1

Address Line 2

City

State

Postal Code

Country

Referral Information

How did you hear about PepUp Tech?

Name of person who referred you (if none, type in the word None)

Name of organization who referred you

If other, please enter organization name (or type in the work None)

Social Media

Please note that both a LinkedIn and Twitter Profile are required to complete registration into this course

LinkedIn Profile (Required): If a LinkedIn is not indicated your application will not be reviewed.

Twitter Profile (Required): If a Twitter account is not indicated your application will not be reviewed.

Trailhead Profile Link (if you have one)

Active Duty or Veteran

TRUE

Military Spouse

TRUE

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Related Experience

Years of Salesforce Experience

Excel Experience Level

Did you know about Salesforce before hearing about PepUp Tech?

YesNo

Will you have Computer and Internet access for the full duration of the program?

YesNo

Can you commit to 10-weeks?

YesNo

Do you have any Salesforce Certifications? You are not eligible for this course if you hold any Salesforce Certifications. We will verify your answer.

YesNo

Languages (select all that apply)

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Work Experience

Are you currently employed?

YesNo

Name of Company

Current Position/Title

Employment Type

Hours work per week (on average)

Hourly Rate (if applicable)

Yearly Income (if salaried)

Authorized to work in the United States?

YesNo

If not authorized, please provide details

Financial Documentation

In order to qualify to enroll in a PepUp Tech course you must be from a low to moderate income background as defined by the FY 2021 Median Family Income Documentation System for your state and county. We verify income as follows:

You must proof of income. Here are some acceptable proofs of income:

If on Public Assistance: Human resources recent budget letter
If Employed: 2019 Most recent tax return and W2 form and 2 pay stubs (must submit all three if choosing this method)
If in college: Pell Eligibility Proof
If in college: State Financial Aid Eligibility Proof
Other (please email admissions@email.com)

In addition to the above you can also submit an optional statement explaining your financial situation if extenuating circumstances exist. This statement alone will require additional follow up from our team to validate income.

Optional - Letter explaining financial situation

2021 Household Gross Income before tax/deductions (include only whole numbers, no symbols or decimals):

Total Household Size

Financial Document #1

Financial Document #2

Financial Document #3

Financial Document #4

Optional Financial Statement

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Supplementary Documents

Upload a recent resume

Upload a copy of your Resume

Upload your statement of interest. Topic: What makes you a great candidate for PepUp Tech Academy? Explain how you think PepUp Tech will enable you to reach your professional goals (300 word minimum).

Upload your statement of Interest

Upload a letter of recommendation (or have your recommender email it to admissions@pepuptech.org)

Upload your Recommendation Letter

Our Policy

PepUpTech is committed to a policy of equal treatment for all individuals applying to attend a PepUp Tech program, volunteer, intern, work or otherwise conduct business with our organization. PepUp Tech does not discriminate on the basis of race, color, gender, handicap, age, religion, sexual orientation, or national or ethnic origin.

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted into the virtual course, I am required to attend the full duration of the program. If I decide to unenroll I must do so in writing by emailing my instructor. I understand that there is no cost to me to attend this course.

Electronic Signature (typing in your name below constitutes an electronic signature):

Full Name

Type in your Full Name

Date

Media Release

I hereby grant permission to PepUpTech, to use, including to display publicly or to perform, the above-named person's image, likeness, or voice recording on the PepUp Tech website or in any other official PepUp Tech publications without further notice or compensation. I hereby consent that any such image, likeness, or voice contained in photographs, recordings, and tapes are the property of PepUp Tech, which shall have the right to print, reprint, publish, copy, vend, perform or represent publicly, or create derivative works based on and using the image, likeness, or voice depicted in such photograph, film, or sound recording as it may desire free and clear of any claim whatsoever on my part or the part of the above-named person.

I also understand that once the above-named person's image, likeness, or voice recording is published on a website, it can be downloaded by any computer user. Personal information, such as full name, addresses and telephone numbers will never be published. If a person’s name is used with a photograph, film, or sound recording, it will be in the form of a first name and last initial. For example, student Jane Doe may be listed as “Jane D.” Therefore, I agree to indemnify, defend and hold harmless PepUp Tech, its officers, employees, agents, successors and assignees (the “Indemnified Parties”) from and against any and all claims and liabilities resulting from this publishing.

Permission is granted for the use requested above:

Electronic Signature (typing in your name below constitutes an electronic signature):

Full Name

Type in your full name.

Date

Thank you for completing this application form and for your interest in attending our virtual course.

- End of Application -