Name *

First Name

Last Name

Mobile Phone *

(###)

###

####

Employment status

This is strictly for the purposes of better understanding your schedule and possible availability for different types of LEAD training. This will not be shared with anyone outside of LEAD Ohio.

Full time

Part time - Day

Part time - Evenings and/or weekend

Full time student

Not employed / Retired

Annual household income level

Because we strive to include a balanced mix of individuals in our training classes, this is helpful in ensuring we are recruiting from socioeconomic groups that are underrepresented in our trainings. LEAD Ohio will not share this information with anyone outside of our organization.

$0 - $10,000

$10,000 - $27,000

$27,000 - $39,000

$39,000 - $84,000

$84,000 - $160,000

$160,000 - $205,000

$205,000 +