BAVC Certificate Enrollment Inquiry

PLEASE READ: If you want to apply for TechSF funds to cover the cost of this certificate program, please DO NOT fill out this application. Apply for TechSF funding at bavc.org/techsf

First Name

Last Name

Phone #

Email Address

Mailing Address

How will you most likely be paying for your certificate?

I'll be paying out of pocket for a Certificate ($3.5-6K)I'll be paying out of pocket for a Fast Track Certificate ($1.5-2.5K)My employer will be covering the cost of the certificateI'm applying through my local unemployment office through WIOA to cover the costThe Department of Rehabilitation is covering the costOther

What is your current employment status?

Transitioning from one field to another (digital media is new to me)Freelance/contractorUnemployed and currently receiving unemployment benefitsUnemployed and NOT eligible for unemployment benefitsEmployed and interested in changing fieldsEmployed and interested in staying in same field while expanding skill setSole Proprietor of a business

Education: Can you provide any of the following? Please check all that apply

High school transcripts showing school completionHigh school diplomaGED or other equivalency documentation Vocational training enrollment or completionCollege transcripts or diplomaEnrollment in the militaryI can provide the item noted above but will need some timeI will not be able to provide any of the above items

If available now, please upload one of the items you have marked in the education question above

Are you interested in adding one-on-one portfolio mentoring instruction

YesNoMaybe later

What are your personal or professional goals as a result of earning this certificate?

What date are you ready to begin training?

What additional resources that BAVC offers are you most interested in?

Other:

I understand that payment in full is required before training can commence.

YesNo