CWA Train the Trainer Registration

All questions must be answered in order to process this form. Please answer all questions completely. Information is kept confidential. By enrolling in this program, I grant permission to share my information with the Maryland Department of Labor and the Maryland Association of Community Colleges. This program reserves the right to check the accuracy of the information below.

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Please select which community college you are registering from:

If "Other", please type the name of the Community College that referred you:

How did you first hear about this program?

Please type the name of the high school that referred you:

Please type the name of the job fair you heard about us at:

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SECTION I: PERSONAL INFORMATION

First Name

Middle Name

Last Name

Full Name

Street Address

City

State

Zip Code

County

Gender

Social Security Number

Date of Birth

Email

Phone

Do you check email often?

Race

Races (Two or more) - please hold ctrl key and click on each applicable race:

If other Race(s), please specify

National Origin

If other, please specify

Have you served or are you currently serving in the military?

Is your spouse currently serving or has he/she previously served in the military?:

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SECTION II: EDUCATIONAL BACKGROUND

Highest Educational Attainment

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SECTION III: IT/CYBERSECURITY EXPERIENCE

Do you have work-related experience in IT and/or cybersecurity?

How many years of experience do you have in IT and/or cybersecurity?

Please describe your work-related experience in IT and/or cybersecurity:

Do you currently have any cybersecurity-related certifications?

Please select which of the following cybersecurity certifications you already have below. Hold the ctrl key on your keyboard and click on each applicable certification.

Please list any other certifications you may have:

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SECTION IV: EMPLOYMENT INFORMATION

Are you currently employed?

Is your current position related to IT and/or cybersecurity?

Are you currently receiving unemployment insurance benefits?

Do you currently or have you ever held a United States Government Security Clearance?

Please describe your clearance history (to the extent you are able to):

Please provide your current or most-recent employment information.

Name of Employer

Job Title

Start Date

End Date

Hourly Wage

Average number of hours worked per week

Are/were you offered health benefits?

Please list additional skills or hobbies:

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Grant Name (From Lead)

SECTION VI: CONSENT

This program is funded by the State of Maryland’s Department of Labor. As a recipient of Maryland grant funds, this program is required by law to collect certain demographic information from training participants and to provide such information to Labor for reporting purposes. By enrolling in this program, I grant permission to share any information contained in this application with the Maryland Department of Labor and the Maryland Association of Community Colleges. I understand and agree with these conditions.

Consent Signature

Consent Date

Application Status

Applicant Source

Snap Eligible

Contact Information