The Well CDC Akron -

Manufacturing Program Application Form

Thank you for your interest in our new manufacturing class. In this program you'll learn the basics of manufacturing and connect to a wide network of supportive services. If you have any questions, please email Jada Ziegler: jada@thewellakron.com

First Name*

Last Name*

Preferred Pronouns?*

Social Security Number*

Date of Birth*

Preferred Method of Contact

Address Line 1*

Address Line 2

City*

State*

Zip Code*

Email*

Phone*

Gender

Ethnicity/Race

Primary Language?

Highest level of education

What are you looking for in a job/career?*

How did you hear about The Well CDC Manufacturing Program?*

Have you ever been convicted of a misdemeanor or felony (this does not disqualify you)? If yes, please explain.*

Please type your full name and today's date below for authorization.