Application Process

You are interested in enrolling in Career Institute's Program?
First find out if you are eligible, print and fill out the Barrier Form. Fill out the Interest Survey below.  Once you submit it, it will be emailed to a Career Institute staff member who will contact you to set up an appointment.  
Print and fill out the  Participant Questionnaire You must bring your Barrier Form and Participant Questionnaire to the interview.

Please note that you must be between the ages of 18-21 and a resident of San Bernardino County to be eligible.

Program Interest Survey
First & Last Name: *
Today's Date: *
Date of Birth: *
Age: *
E-mail Address: *
Residence Address:
(street, apt # city, state,  zip)
Home phone: *
What Certification Program are you interested in? (CNA, Personal Care Aide, Hospitality Management, GED completion or Hinkley) *
Cell Phone: *
What is the BEST way to communicate with you?:
What is your Facebook Name?:*
Would you accept Career Institute as a friend on Facebook?:
Are you a U.S Citizen?:
Number in Family (including you): *
Do you have children? If yes, names and ages:
Do you or your family receive any form of Public Assistance?:
If yes, check all that apply:
Family TANF
  Family SSI/SSP
 Other: Food Stamps
Are you disabled or do you have any disabilities?:
Have you even been convicted of a crime?:
If YES, please indicate Felony or Misdemeanor:
What is the highest grade level you have completed?: *
Expected graduation date (if applicable):
What High School are you attending/did you attend?: *
Have you completed any vocational training?:
If yes, what kind of training did you receive?:
Have you ever applied for WIA Service?:
If yes, when and where?:
Are you currently employed?:
If yes, Employer name:
Job title:
Date started:
Hourly rate:
 How did you hear about our program at Career Institute?: *


Don't forget to fill out the Participant Questionnaire and give yourself time to fill it out thoroughly. 

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