Access and Educational Opportunity Center Pre-Registration Form

* fields are required

Thanks for your interest in Tri-C Access Centers! Completing this form is your first step to enrolling in a program or course.

If you have questions or need help filling out the form, contact Hugh Littleton at hubert.littleton@tri-c.edu or 216-987-0328.

First Name: *

Last Name: *

Address: *

City: *

Zip : *

County: *

Phone: *

Email: *

Tri-C Snumber (if you already have one):

Are you currently employed?: *

YesNo

Who is your current employer?: *

What is your job title?: *

If you are a MetroHealth employee, please provide your MetroHealth I.D. number:

If you are a RTA employee, please provide your RTA employee I.D. number.:

Did you graduate from high school or earn a high school diploma equivalent?: *

YesNo

Select all that apply:

Attended some college
Completed college degree
Completed trade school
Completed a certificate program

Select your Access Center location: *

Select the Access Center programs or courses you are interested in*: *

Workforce Success Course (Discover your employable skills)
Adult Diploma Program (Earn your high school diploma and a credential for an in-demand job)
Basic Computer Skills (New technology user)
English Language Learners (Includes reading, writing, speaking and listening)
Medical Terminology (Introduction to medical vocabulary)
Microsoft Office Skills (Intermediate instruction in Microsoft Office)
Supply Chain and Logistics (Learn skills needed to work in a warehouse environment)
Women in Transition Program (Personal development)
Other

Other program or course: *

*Program offerings are subject to change based on demand and availability.

Other support needed: *

Are you currently attending or interested in completing a workforce training program and/or attending college?: *

YesNo

Other program: *

To ensure you are connected to all resources in our network, please confirm if you currently receive TANF benefits: *

YesNo

Select all benefits received: *

Are there additional services that would be helpful to you or anything else you would like to share?:

Where did you hear about the Tri-C Access Centers?: *

Other (please specify): *

Submission of this form confirms your consent for Tri-C or Access Center team members to contact you related to your educational and career interests, and to share this information with Access Center partners, including the TriO Educational Opportunity Center.

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