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General Eligibility
General Eligibility
Avada Support
2023-12-08T16:09:22+00:00
If you would like assistance with the application, please call Terilynn at 272-228-1365.
Eligibility Form
Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
County
Lackawanna County
Luzerne County
Other
Phone Number
(Required)
E-Mail Address
(Required)
Marital Status
(Required)
Please Choose A Status
Single
Married
Divorced
Widowed
Other
If Other
Household Composition
Are you the Head of the Household?
(Required)
Yes
No
How many children do you have?
(Required)
What is your annual individual (personal) income?
(Required)
What is your annual household income?
(Required)
How many over 18?
(Required)
What is your highest level of education?
(Required)
Please Choose A Level
Less Than High School
High School Diploma or GED
Some College, No Degree
Postsecondary Non-Degree Certification
Associate's Degree
Bachelor's Degree
Master's Degree
Are you authorized to work in the United States?
(Required)
Yes
No
Do you have a high school diploma or GED?
(Required)
Yes
No
Have you ever been convicted of a felony?
(Required)
Yes
No
Have you ever been convicted of a violent crime?
Yes
No
Which certification track are you interested in?
Certificate Tracks
Medical Assistant
Building Property Maintenance
Diesel Preventative Maintenance
Welding Technology
Industrial Technology
Industrial Maintenance
Welding
Essay
Describe a specific time when you were faced with a challenge and solved the problem.
(Required)
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