DSCI Inquiry Form

Please submit the form below to be considered for a BCR Cyber program. Following receipt of your application, a BCR Cyber team member will review your application and identify the most suitable program for you. Our team will then reach out to you to discuss next steps.

Answer questions completely except for those which do not apply. Information is kept confidential. All training programs currently offered by BCR Cyber that may apply to you are funded by the Maryland Department of Labor. By enrolling in this program, I grant permission to share my information with the Maryland Department of Labor. This program reserves the right to check the accuracy of the information below.

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Are you currently enrolled at a Maryland community college?

Please select which Community College referred you to the program:

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

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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SECTION V: NEW EMPLOYMENT

This program is intended for individuals looking for new employment in the IT/cybersecurity field.

Are you looking for new employment in IT/cybersecurity?

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Grant Name (From Lead)

SECTION VI: CONSENT

BCR Cyber's programs are funded by the State of Maryland Department of Labor. As a recipient of the Maryland Department of Labor's funding, these programs are required by law to collect certain demographic information from training participants and to provide such information to Labor for reporting purposes. Any demographic information provided to Labor will not contain personal identifiable information. By enrolling in this program, I grant permission to share my demographic information with Labor. I understand and agree with these conditions.

Consent Signature

Consent Date

Application Status

Applicant Source

Snap Eligible

Contact Information