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Galveston College Continuing Education

Begin your Quickstart application process here.

Quickstart Intake Form

Last Name

First Name

Middle Initial

Address

City

State

Zip Code

Email Address

Contact Phone Number

Program Interest: Electrical Helper QuickstartHVAC Quickstart

Gender: MaleFemale

Date of Birth (Use MM/DD/YYYY Format):

Are you a citizen of the United States or certified to work in the United States? (You must bring in a Social Security card or original I-9 documents to required meeting with Job Placement Navigator upon acceptance into Program.) YesNo

Are you registered with the U. S. Military Selective Service, required of all males 18-16? (Please bring your Registration Acknowledgment Card.) YesNo

Are you a U. S. Veteran? YesNo

Are you currently employed? YesNo

Goals Statement

Please write a short paragraph telling us why you want to be given this opportunity and what you hope to gain from it. Expand on why you think you would be a good candidate for this program.

What obstacles, if any, do you see as a barrier to your regular attendance and completion of the program? TransportationChild CareConflict with Work SchedulePurchase of Steel Toe BootsPersonal Support System (friends, family, other)Health ConcernsMath or English (listening, speaking, reading, or writing)Other

By submitting this interest form, I understand that I will be contacted by a representative of Galveston College for an Intake Interview via phone and/or in person. Completion of this form does not necessarily mean that I am accepted into the Quickstart Electrical or HVAC Helper Program. If you have any questions you may contact Mary Powers at 409-944-1287 or mpowers@gc.edu. Se habla español.

In Person

Moody Hall – Room 140

Mail

Galveston College – Continuing Education
4015 Avenue Q, Suite M-140
Galveston, TX  77550

Phone

409-944-1344

Fax

409-944-1501