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4. CITY OF HOLLYWOOD WORK SKILLS TRAINING SCHOLARSHIP PROGRAM - Preliminary Application
6. Only those applicants residing within the City's Low to Moderate Income (LMI) neighborhoods may participate in this Program (indicated by the blue shaded areas in the map below). All submitted applications will go through an address verification process to ensure that participants meet this Program requirement. Participants must also self-certify their household income and provide proof of their U.S. Citizen or resident status.
8. City of Hollywood Low to Moderate Income (LMI) Areas
   
10. First Name*
11. Last Name*
13. Address*
15. City*
16. State*
17. Zip*
19. Phone Number*
20. Email Address*
22. Total Number of Household Members*
23. Total Annual Household Income From All Sources*
24. Do you have a high school diploma or GED?*

    1. Yes
    2. No

    Response does not disqualify your application.
26. Are you a U.S. Citizen or lawful permanent resident?*

    1. Yes
    2. No
27. What type of valid (unexpired) government-issued photo ID will you be providing?*

    1. U.S. Passport
    2. Driver License
28. Please enter the number of your valid (unexpired) government-issued photo ID.*
30. Select the Work Skills Training Scholarship Program you are applying to below:*
    -- Select One --Introduction to Broadband and Fiber Optic Technology • Saturdays • 9am-4pm • April 15-August 12, 2023
32. Are you able to attend all the class sessions?*

    1. Yes
    2. No

    Class sessions will be held at the Washington Park Community Center, located at 5199 Pembroke Rd, Hollywood, FL 33023 during the dates/times listed above.

34. Acknowledgement*
    -- Select One --YesNo

    I hereby certify that the above statements are true, correct and complete to the best of my knowledge. I understand that a false statement may disqualify me for the City of Hollywood Work Skills Training Scholarship Program.

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36. Submit

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