Access Centers 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 AccessCenters@tri-c.edu or 216-987-4238.

First Name: *

Last Name: *

Address: *

City: *

Zip : *

County: *

Phone: *

Email: *

Tri-C S-Number (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:

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: *

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.

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