Workshop Registration Form

Prior to viewing the Online Orientation, we would appreciate if you would register with us. It should only take a minute or two.

Please respond to the following questions.

Today's Date *

Please use this date format mm/dd/yyyy

First Name *

Middle Initial

Last Name *

Date of Birth *

Please use this date format: mm/dd/yyyy

Street Address *

Street Address 2

City

State *

Zip Code *

Email Address

Gender Identity *

Primary Phone *

Other Phone

Eligible to work in the United States *

Race *

Ethnicity *

Education Level *

Citizenship *

Veteran Status *

Is your spouse a veteran?

Employment Status *

Are you currently receiving any of the following *

None
SSI
SSDI
SNAP
TANF/OWF

OhioMeansJobs Lucas County may share and disclose my information for employment and training services to partner organizations. *

Yes
No

Please enter your full name. *