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Application Form
WHY DO WE ASK FOR THIS INFORMATION? CLICK HERE
SECTION: GENERAL INFORMATION
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First Name
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Last Name
Mobile Phone Number
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Date of Birth
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Email Address
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In what County do you reside ? (e.g. Frederick, Howard, Montgomery, etc)
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Race
Asian
Black/African American
Hawiaan/Pacific
Hispanic/Latino
Native American/American Indian
White
2 or More Races
Other
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Sex
Male
Female
Other
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Country of origin?
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Highest Level of Academic Achievement
Some High School or Less
High School Diploma/GED/Equivalent
Some College
Associate's Degree
Bachelor's Degree
Advanced Degree (Master's. PhD. other)
Trade School
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Have you served/are currently serving in the Military or is your spouse currently serving in the Military? (select YES if any apply)
Have you served/currently serving in the Military.
Yes
Have you served/currently serving in the Military.
No
SECTION: EMPLOYMENT INFORMATION
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Employed/Unemployed
Employed
Unemployed
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Current Title/Position
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Current Company of Employment
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Avg # Hrs Worked/Week in current position?
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What is your current salary range? NOTE: This information is for tracking purposes only
What is your salary options?.
Less than $10000
What is your salary options?.
$10000 to $14999
What is your salary options?.
$15000 to $24999
What is your salary options?.
$25000 to $34999
What is your salary options?.
$35000 to $49999
What is your salary options?.
$50000 to $74999
What is your salary options?.
$75000 to $99999
What is your salary options?.
$100000 to $149999
What is your salary options?.
$150000 to $199999
What is your salary options?.
$200000 or more
SECTION: ADDITIONAL INFORMATION NEEDED
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How did you hear about us?
Facebook
Instagram
LinkedIn
Twitter
Employer
Coworker
Techfrederick Board/Advisory Board member
Email notification
OTHER
If other, please specify
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Are you a member of Tech Frederick?
Are you a member of Tech Frederick?.
Yes
Are you a member of Tech Frederick?.
No
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Training Course Selection
Training Course Selection.
Machine Learning Powered Search
Training Course Selection.
Communicate to Persuade Motivate and Drive Change
Tech Frederick reserves the right to check the accuracy of the information provided.
Tech Frederick is able to provide our community with training and development through funding by the Department of Labor, Licensing and Regulation (DLLR) in the form of the EARN Grant. Information gathered through the registration process is confidential and only shared with the DLLR for reporting purposes.. By submitting this form, you must agree to complete additional registration information and post training follow up surveys required by Tech Frederick and the MD DLLR for participation in this training.
I understand that failure to complete forms with all required information will result in an invoice for training costs and that I will be responsible for paying this fee.
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I agree to the Terms above
I agree to the Terms above.
Yes
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