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2024-2025 CFSI Application
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First Name
Middle Name
Last Name
Preferred / Nickname
Phone Number
Mailing Address
Mailing Address
Country
Street
City
Region
Postal Code
Birthdate
Birthdate
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Email Address
Education
Do you have your GED/HSD?
Do you have your GED/HSD?
Yes
No
A GED/HSD is a prerequisite of this program. What are your plans to obtain one before the next cohort begins?
Have you ever been to college?
Have you ever been to college?
Yes
No
List all Universities/Colleges you have attended. Include approximate dates attended.
Have you ever received any degrees or certifications?
Have you ever received any degrees or certifications?
Yes
No
If yes, please explain.
Do you have any outstanding student loans?
Do you have any outstanding student loans?
Yes
No
(Approximately) How much?
Are you currently in default with those loans?
Do you have a transcript hold anywhere?
Do you have a transcript hold anywhere?
Yes
No
Unsure
Where and how much is owed in order to have it released? (Please call the university or college and check for accuracy.)
Have either of your parents obtained a 4-year degree?
Have either of your parents obtained a 4-year degree?
Yes
No
Have you ever taken PRSS training through OCARTA or the Department of Mental Health?
Have you ever taken PRSS training through OCARTA or the Department of Mental Health?
Yes
No
If yes, are you PRSS certified?
Yes
No
(Optional) If no, provide any additional details about your PRSS training certification status.
Employment
Are you currently employed?
Are you currently employed?
Yes
No
Employer 1:
What is your current work schedule at this employer?
Employer 2 (Optional):
What is your current work schedule at this employer?
If currently unemployed, when was the last time you were employed?
List where you have previously worked and for approximately how long?
If accepted into CFSI, would you be able to come to any of the paid ($10/hr), in-person training hours (Monday-Thursday 8:30AM-4:00PM)?
Some
Most
All
None-I would only be able to take classes and would still need to work full-time
General Info
Do you currently own a laptop?
Do you currently own a laptop?
Yes
No
What brand is it and what year was it made?
Do you have wi-fi at your place of residence?
Do you have wi-fi at your place of residence?
Yes
No
If not, how do you plan to gain internet access?
Personal
Please list career goals/interests.
If you could do anything in the world (your dream job), what would that be?
What has prevented you from doing that?
What are you good at (skills)?
What are your hobbies?
Is there anything in the community you’re passionate about and why?
What do you do in your free time?
How did you hear about us?
What accomplishment are you most proud of?
What is one word that you would say is your inspiration word?
What does "growth mindset" mean to you?
References
Please list (3) personal references. For each reference, please provide their first and last name, phone number, email address, and length of time you've known them.
A leader/mentor
(someone who you go to for guidance)
The person who referred you
Current or previous employer
Essay
Submit an essay telling us Who you
are
, Who you
were
, and Who you want to be in the
future
. The essay should be at least one full, single-spaced page or 500 words. This essay may have a direct impact on your acceptance or denial into the program. If accepted, this essay may be used to place you into the appropriate reading and writing classes, so please make sure it is your best work. Do not have someone else write this essay for you.
Instead of uploading a document, you may type your essay here (500 words):
Submit
