Please place a checkmark (below) of all items that apply to you.  Return this form and the Program Coordinator will contact you to set up a time to meet to discuss this opportunity to increase your income.

                        I want to obtain a higher paying job (I am already working).

                        I want to obtain employment (I am not currently working).

                        I need to be able to fill out a job application.

                        I need a professional-looking resume.

                        I need job training.

                        I need job placement.

                        I need information on jobs and salaries.

                        I want to improve my Reading/Math/English skills (circle those which apply).

                        I do not have a high school diploma.

                        I want to obtain a GED.

                        I want to obtain vocational-technical education.

                        I want to obtain a college education.

                        Mark One:                     2-year college                            4-year college

                        I want to obtain a driver’s license.

                        I need transportation.

                        I need childcare.

                        I would like to improve my parenting skills.

                        I need counseling on family matters.

                        I need counseling for personal problems.

                        I need counseling and/or treatment for substance abuse.

                        I need to get treatment for medical or dental issues.

                        I need assistance with utilities.

                        I need assistance with food.

                        I need training in household management.

                        I need training in money management.

                        I need to establish credit.

                        I need to correct a bad credit rating.

                        I need counseling and/or information on home ownership.

                        I need to clear up some legal matters.  Regarding:                                                          

                        I need to move to another area (outside Muskogee) for job purposes.