Step 1 of 3 33% General InformationFirst NameMiddle NameLast Name Personal Demographic Date of Birth MM slash DD slash YYYY RaceAmerican Indian or Alaskan NativeAsianBlack or African AmericanHispanicNative Hawaiian or Other Pacific IslanderPrefer not to answerTwo or more racesWhiteGender Female Male Non-binary Other If OtherContactPhoneEmail Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country How did you hear about the program? Agency Outreach Event/Recruitment Activity Social Media Outreach/Digital Communication EARN MD B&O Cafe Other If Agency, type hereIf Other, type hereTell us why you think the Dignity Plates Training Academy will be a pathway toward your success.Specifically, why are you applying to the Franciscan Center's Dignity Plates Training Academy? EmploymentAre you legally entitled to work in the US? Yes No Do you have food service experience? Yes No Are you a veteran? Yes No Do you receive any of the following? IDA SSI SSDI Food Stamps / SNAP TANF Veteran's Benefits Veteran's Healthecare Child Support Wages Medicare Unemployment WIC EducationHighest Education Level--- Select a Value ---Elementary/ Middle SchoolSome High SchoolGEDHigh School DiplomaSome CollegeAssociates DegreeBachelor's degreeMaster's Degree/ Ph.DHousingDo you have a stable place to stay for the next 6 months? Yes No Current living situation--- Select a Value ---Living with Friends/ FamilyPermanent Subsidized HousingProgram/ ShelterStreetTraditional HousingOtherAre you responsible for the care of any children or family member(s)? Yes No LegalDo you have any pending court cases? Yes No Have you ever been found guilty of a crime or misdemeanor? Yes No Do you have any current warrants? Yes No Substance Abuse HealthHave you ever used drugs or alcohol? Yes No Have you ever been diagnosed with a mental illness? Yes No Is there anything else Franciscan Center of Baltimore should know?CAPTCHA
