CarePRO Virtual Bootcamp Interest Form
CarePRO is a healthcare career readiness bootcamp to review career exploration, entry-level certifications, and the skills needed to launch your healthcare career. Please fill out the interest form below to receive the Zoom Registration Link. If you have questions, contact Domonique Bulls at dbulls@ulgatl.org Next Virtual Bootcamp: TBD (you will be notified when the next virtual bootcamp is scheduled)
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Date of birth
*
-
Month
-
Day
Year
Date
Are you over the age of 18?
*
Yes
No
Age
*
What county do you live in?
*
Education level
*
Current Employer
*
Job Title
*
Monthly income
Monthly income (this information is used to funding eligibility)
*
Gender
*
Please Select
Female
Male
Non-binary
I prefer not to answer
Race
*
Black or African American
Asian
Latinx
White
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