Workforce Student Questionnaire | Piedmont Virginia Community College

First Name*

Last Name*

Email *

Email Confirmation*

Phone #*

PVCC Student ID #

Birth Date

County of Residence*

Have you lived in Virginia for the past 12 months?*

Yes

No

Do you have a Virginia Driver's License or DMV-issued photo ID? *

Yes

No

Are you currently employed?*

Yes

No

Are you currently receiving unemployment benefits?*

Yes

No

Do you wish to get a job upon completion of training?*

Yes

No

What was your adjusted gross income on your 2021 tax return?*

How many dependents did you claim on your 2021 tax return?*

Are you currently receiving SNAP benefits?*

Yes

No

Are you currently registered with Network2Work@PVCC?*

Yes

No

Program of Interest - First Choice*

Program of Interest - Second Choice

Why do you think this program is a good choice for your next career?*

Do you have concerns about any of the following affecting your ability to participate in and complete this training program? (check all that apply)*

Is there any other information about your training goals that you wish to share with the coaching and funding team?