Apply for Workforce-Funded IT Training in Arkansas

👤 Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

Date of Birth *

Last 4 Digits of SSN *

🔒 Only the last 4 digits are collected for identity verification. Your data is encrypted and stored securely.

📍 Home Address

Street Address *

City *

State *

ZIP Code *

🎓 Educational & Professional Background

Highest Education Level *

Current Occupation *

Are you currently employed? *

Yes, Full-time Yes, Part-time No, Unemployed Self-employed Student

Have you previously worked in farming or agriculture? *

Yes No

This information may qualify you for additional funding or grant opportunities.

Are you a U.S. Veteran? *

Yes No

📚 Course Selection

Select Your Course *

Preferred Start Date

Optional — we'll work with your schedule.

Preferred Class Schedule *

Do you have reliable transportation? *

Yes No

Are you currently receiving any financial assistance? *

Yes No

e.g. SNAP, WIA/WIOA, TAA, unemployment benefits, etc.

How did you hear about us?

Additional Notes

🆘 Emergency Contact

Emergency Contact Name *

Emergency Contact Phone *

Relationship *

📝 Reference (School Teacher / Manager / Supervisor)

Please provide a reference from a current or previous teacher, school administrator, or employer.

Reference Full Name *

Reference Phone *

Reference Title / Position *

School / Organization *

Reference Email

Optional but recommended.

✅ Agreement & Consent

I confirm that all information provided is accurate and complete. I understand that falsifying information may result in removal from the program.

I agree to SkillForge Academy's Terms of Service and Privacy Policy and consent to being contacted regarding my enrollment.

🔒 Your personal information is encrypted and securely stored. We will never sell or share your data.

Start Your Learning Journey

Student Enrollment Application

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