CAP Services’ Skills Enhancement Program Screening/Application Form

Individuals must be working at least 20 hrs/week and have a household income at or below 200% of the federal poverty guidelines. When you complete the form and click “send”, it will automatically be emailed to the Skills Development Manager in your county for review. If you qualify, an application will be sent to you to be completed.

    Fields marked with asterisk (*) are required.

    Personal Information

    Name
    Your Name (Last, First, M.I.)*

    Birth Date*

    Gender*
    MaleFemaleNon-binary/third genderPrefer not to sayPrefer to self-describe

    County*

    Contact
    Phone*

    Alternate Phone

    Email Address

    Confirm Email Address

    Best way to contact you?

    Income Information

    Employer

    Job Title

    Hours per week*

    Wage per hour*

    How many people live in your household:*

    How many dependents do you support:*

    Do you have a significant other with earned income: *

    Significant other's income (Annual):

    Does the household have any other income? *
    Type of income Amount $

    Public Assistance

    Is your family currently receiving any public assistance?*

    Examples: BadgerCare, Medicare, FoodShare, WIC, Child Care Assistance, Housing Assistance, Energy Assistance, etc...

    Education

    What type of degree or training program do you want to pursue?

    Are you currently enrolled in an education/training program?

    If so, where?

    How long will it take you to achieve this goal?

    What other resources have you explored to assist you with this goal?

    Other Information

    How did you hear about the Skills Enhancement Program at CAP Services, Inc?

    Is there anything unique about your situation that you would like to share?

    PLEASE EXPECT A CALL OR EMAIL FROM A SKILLS DEVELOPMENT MANAGER WITHIN ONE WEEK OF SUBMITTING FORM