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

Date of birth County of residence

Are you older than 18? National origin

Sex Race/Ethnicity

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

For which upcoming class are you applying? How far are you willing to travel for work? (select the maximum)

Highest level of education Referral type