El Barrio Workforce Development Enrollment First Name* Last Name* Email* Street* City* State/Province* OH Zip Code* Phone Mobile You have my consent to send text message: --None--NoYes Birthdate:* Country Of Birth:* Are you pregnant:* --None--YesNo Number Months Pregnant: Gender:* --None--FemaleMale Which race do you most identify with:* --None--African American or BlackWhite/CaucasianAsianMulti-RacialNative American/Alaskan NativeNative Hawaiian-Other Pacific IslanderOtherRefused to answer Which ethnicity do you identify with:* --None--African AmericanArabicEgyptianHispanic/LatinoIndianLiberianSomaliVietnameseWhite Primary Language:* --None--EnglishSpanishMandarinJapaneseGermanRussianArabic English Proficiency:* --None--FluentGoodFairLow Education Completed:* --None--9th Grade10th Grade11th Grade12th GradeHigh School DiplomaGEDTechnical SchoolSome CollegeCollege - Two YearCollege - Four Year Have you ever had an IEP:* --None--NoYes Martial Status:* --None--SingleMarriedSeparatedDivorcedWidowed House Hold Size:* Family Size:* Adults In House Hold 19 & Over:* Seniors In House Hold 65 And Over:* Child 1 DOB: Child 2 DOB: Child 3 DOB: Child 4 DOB: Monthly Family Income:* $ # Of Drivers In Household:* # of Vehicles In Household:* Vehicle Available For Your Use:* --None--YesNo Are Your Transportation Cost Affordable?:* --None--YesNo How Much Do You Spend On Transportation?:* --None--Less than $5$6 - $10$11 - $30$31 - $50More than $50 Do you require any special accommodation: Did you lose a job because of COVID-19:* --None--YesNo Trouble finding job due to Covid-19:* --None--YesNo Do you have internet access:* --None--YesNo How did you hear about us:* --None--211-LineBillboardCareer FairCircle HealthCommunity OrganizationCraigslistCurrent/Former ClientEvent/Fair/PresentationFacebookFamily/FriendFlyerFormer/Current ClientRadioCounty Worker Please review the required information above.