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Code:You Application

* Required

First Name

Last Name

Preferred Name

Phone

SMS Opt-in: Can we send you SMS/texts about program reminders, schedules, class info, etc?

Yes, you may text this phone number

Birth Date

Please use format mm/dd/yyyy

Street Address

City

State

We are funded by several grants that only allow us to serve residents of certain Kentucky counties. Mainly, the Greater Louisville and Appalachian/Eastern Kentucky regions. If you do not live within our region, you are ineligible to participate. However, you can select “Other” and if we eventually open up service in your area we can contact you.

Zip Code

County of Residence

Please be sure to select the proper county to ensure you get into the program that serves your region.

Gender

Are you fluent in English?

Are you authorized to work in the United States?

Are you a veteran?

Do you identify as LGBTQ+?

Do you have a disability?

What is your employment status?

If unemployed, please select the status that best applies to you:

Leave blank if you are employed

Are you currently employed in the technology industry or interested in gaining employment in a technology-related field?

Have you ever been convicted of a felony?

Marking yes will not disqualify you from the program

Do you/your household qualify low income-based government services and/or programs, such as SNAP, SSI, TANF, etc? Or do you otherwise feel your household qualifies as no- or very low income?

Please check any of the following services that apply to you as of today’s date:

SNAP

TANF

Unemployment Insurance

SSI

Medicaid

What is your housing situation?

Temporary Housing – living in emergency shelters, motels, hotels, trailer parks, cars, parks, public spaces, or abandoned buildings, and those sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason. Transitional Housing – a project designed to provide housing and appropriate supportive services to homeless persons to facilitate movement to independent living. The housing is short-term, typically less than 24 months.

Highest level of education completed?

Are you currently enrolled in a college or university and/or pursuing a degree?

Do you struggle to find full-time or good-paying employment because of a history with (or previous incarceration due to) substance abuse or misuse?

Do you have a laptop or desktop?

Regular access to a computer is required to participate in the program. If you do not have one, Mark No, and someone from our team will reach out to determine need and possibly connect you with resources if you qualify.

Do you have consistent access to stable internet?

Coursework and all class meetings are held virtually, and you will need Internet access to participate.

How do you rate your computer skills?

Novice

12345

Expert

1) Novice: I can access email 2) Basic: I can access common applications, such as Word Documents 3) Intermediate: I use computers every day and consider myself tech-savvy 4) Advanced: I am well advanced in using computers 5) Expert: I am well established in using professional tech skills such as software development or supporting business computers

Are you willing to commit 10-20 hours of work per week to the program?

This is an accelerated program that requires a considerable time investment each week for successful completion.

How did you hear about Code:You?

If someone referred you to this program, please enter their first and last name or the name of the referring organization.

I agree, understand and/or acknowledge that:

I agree.The submitted information above is true and complete to the best of my knowledge. The submitted information will be entered into the Code Kentucky / KentuckianaWorks database. Code Kentucky / KentuckianaWorks will NOT report my identifying information, any data reported will be void of name, address, or other identifying information. Code Kentucky / KentuckianaWorks has my permission to use the above information for follow-up (enrollment) activities related to the program. Neither Code Kentucky nor KentuckianaWorks discriminate on the basis or race, color, national origin, sex, religion, age or disability in employment or provision of services.

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