Apply for Google Certificate Program

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Application for Google Certificate Program

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Zip Code *

Which Google Certificate is most interesting to you? *

IT Support Specialist Data Analytics

I am 18 years of Age or Older *

Yes No

Gender *

Female Male Transgender Non-Binary Other Prefer Not to Say

Race *

Caucasian or White Black or African American American Indian/Alaskan Native Asian/Native Hawaiian/Other Pacific Islander Prefer Not to Identify

Ethnicity *

Hispanic/Latino Ethnic Origin Not Hispanic/Latino Prefer Not to Identify

Number of people in your household/family? *

Veteran and Military Family Status *

Veteran/History of Military Service Member of military family (immediate family member in the military or a Veteran) Not a Veteran or member of military family

If a Veteran, what was your Military Discharge Status? *

Honorable General, Less Than Honorable Bad Conduct, General Court Martial Bad Conduct, Special Court Martial Dishonorable Other

If a Veteran, select Veteran Status Categories: *

Post 9/11 Veteran with Service-Connected Disabilities

Annual income: *

$0-$9,999 $10,000 - $19,999 $20,000 - $29,999 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $59,999 $60,000 - $69,999 $70,000 +

Select all categories that apply to you: *

History of Substance Abuse Dislocated Worker Non-English Speaker/English as a Second Language Lack of Literacy Immigrant/New American Refugee LGBTQ2SIA+ Single Parent None of these

Disability categories: *

Blindness or Other Visual Impairment Deafness or Hard of Hearing Other Physical Disability Neurological Disability Learning Disability other than Autism Developmental Disability other than Autism Autism Psychiatric Disability Emotional Disability Other Disabling Condition None of these

Education Level (one choice only) *

No formal schooling completed Completed 8th grade Less than high school diploma High School Diploma GED/high school equivalency Postsecondary non-degree award Associates degree Bachelor’s degree Graduate degree

Are you currently enrolled in any of the following? *

High School Diploma GED/high school equivalency Postsecondary non-degree award Associates degree Bachelor’s degree Graduate degree None of these

Have you received a certificate, or a credential issued by an industry or professional organization or certifying body? *

Yes No

How many degrees, certificates, or credentials related to the same occupation or industry do you have? *

List all degrees, certificates, or credentials issued by an industry or professional organization or certifying body. *

Do you, or someone in your household, own any of the following? Select all that apply. *

Desktop computer or laptop Smartphone Tablet or other wireless computer Another type of computer

Please specify *

*

None of these

Do you have access to the Internet in your current living space? *

Yes, a cellular data plan for a smartphone or other mobile device Yes, Broadband (high speed) Internet service such as cable, fiber optic, or DSL service installed Yes, Satellite Internet service installed Yes, Dial-up Internet service installed Yes, Other service – please specify:

Please specify *

*

No access to the Internet in my current living space

If the above is checked: how many miles to your nearest public access to the Internet? *

Select the answer that better describes you:

I will be able to achieve most of the goals I have set for myself. *

Strongly Agree Agree Neither agree or disagree Disagree Strongly Disagree

When facing difficult tasks, I am certain that I will accomplish them. *

Strongly agree Agree Neither agree or disagree Disagree Strongly disagree

In general, I think I can obtain outcomes that are important to me. *

Strongly agree Agree Neither agree or disagree Disagree Strongly disagree

I believe I can succeed at most any endeavor (anything) I set my mind to. *

Strongly agree Agree Neither agree or disagree Disagree Strongly disagree

I will be able to successfully overcome many challenges. *

Strongly agree Agree Neither agree or disagree Disagree Strongly disagree

I am confident that I can perform effectively (do well) on many different tasks. *

Strongly agree Agree Neither agree or disagree Disagree Strongly disagree

Compared to other people, I can do most tasks very well. *

Strongly agree Agree Neither agree or disagree Disagree Strongly disagree

Even when things are tough, I can perform quite well. *

Strongly agree Agree Neither agree or disagree Disagree Strongly disagree

Select the answer that better describes you:

New ideas and projects sometimes distract me from previous ones. *