Oregon Tradeswomen's Lane County TACC Program: Summer 2024

First Name *

Last Name *

Email *

City *

State/Province *

County *

Zip *

Self-Identification Survey

Please select the statement below that most accurately depicts your interest in Oregon Tradeswomen's pre-apprenticeship program: *

I am interested in a career in the trades.
I have a family member who may be interested in a career in the trades.
I am an educator with students who are interested in a career in the trades.
I am a counselor with clients/students who are interested in a career in the trades.
Other

For grant reporting purposes, we ask interested applicants to respond to the self-identification survey below. Completion of the form is entirely voluntary. Any information that you do provide will be recorded and maintained in a confidential file.

Gender Identity *

Female
Male
Non-Binary
Two-Spirit
Other
Decline to Self-Identify

Are you Hispanic or Latinx? *

Race *

American Indian or Alaksan
Asian
White
Black/African American
Native Hawaiian or Other Islander
Hispanic/Latinx
Two or more races
Other
Decline to Self-Identify

Do you identify as BIPOC? *

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to:<br>Autism; Autoimmune disorder (ex: lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDs, and others); Blind or low vision; Cancer; Cardiovascular or heart disease; Celiac Disease; Cerebral palsy; Deaf or hard of hearing; Depression or anxiety; Diabetes; Epilepsy; Gastrointestinal disorders (ex: Chron’s disease, irritable bowel syndrome, and others); Intellectual disability; Missing limbs or partially missing limbs; Nervous system condition (ex: migraine headaches, Parkinson’s, multiple sclerosis, and others); Psychiatric condition (ex: bipolar disorder, schizophrenia, PTSD, and others)

Do you identify as having a disability? *

How did you hear about Oregon Tradeswomen? *

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Oregon Tradeswomen's Lane County TACC Program: Summer 2024

Self-Identification Survey

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