LIFT Application

Apply to LIFT

Please provide us with some basic information about you.

Fields marked are required.

Your name

PrefixFirst Name Middle NameLast Name Suffix

Contact

Email Phone

Address Address Line 1 Address Line 2

City State/Province Postal Code

Employment

Average # of hours worked per week at current job (if unemployed, input "0") Hourly wage at current job (if unemployed, input "0")

Employed at the time of enrollment? Current or former member of the military or a military spouse?

About you

National origin Sex

Upload State/Federal issued ID JPG, PNG, WEBP, HEIC or PDF. Maximum file size 10 MB.

For which upcoming class are you applying? Race/Ethnicity

Cell phone carrier How far are you willing to travel for work? (select the maximum)

Referral type Are you older than 18?

Date of birth County of residence

Highest level of education