LGBTQ+ CAREER DEVELOPMENT PROGRAM APPLICATION

Welcome to Spectrum Health and Grand Rapids Price Center's LGBTQ Career Development Program. Before you get started with the application, please take a moment to go over the program requirements. Space is limited and pre-registration is required for this 3 month, 6 class program. Once your registration has been confirmed, you will receive instructions on how to prepare for the program  

  1. Applicants must be over the age of 18.
  2. Applicants must have at minimum a High School Diploma, GED or be in the process of obtaining a GED before the end of the course (March 21, 2016) If you do not have your GED and would like resources to help in obtaining it, please continue to fill out the form below and you will be contacted within 72 business hours.
  3. You must have a non-expired State, Native American Tribal document or U.S. Government issued id. If you do not have a current id, please let us know and we can connect you to resources to obtain one.
  4. A valid email or phone number you can be reached at for a representative from The Network to follow up on application.
  5. Since space is limited, only participants who can commit to the majority of the 6 workshops will be considered for this session. CLASS SCHEDULE
Legal Name *
Legal Name
Preferred Name
Preferred Name
Note: Only your preferred name will be used during group and communication unless otherwise directed by you.
If you checked "Other" for pronoun please fill in how you would like to be identified.
Mailing Address
Mailing Address
If you currently do not have a permanent address please let us know and we can help you obtain a mailing address.
Phone
Phone
Highest level of education completed
I have access to the following id. *
please check all that apply. If you do not have access to state or federal id, do you need help attaining id?
Pick Up can be arranged for individuals in a 15 mile radius of our center.
please list all languages you are able to communicate in both speech and writing.
The information gathered in this form is solely for use by The Lesbian Gay Community Network of Western Michigan (The Network). Your information will not be shared with any 3rd party. Would you like to be added to the Grand Rapids Pride Center's mailing list?
I certify that the above information is true and correct.