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Culinary and Leadership Academy Summer Masterclass
Registration Form

As seen on

A FREE 3 day Workforce Development Program Powered by

The Chef Jeff Project In Partnership with:

First name

Last name

Age

Gender

Male

Female

Prefer Not To Say

e.g., 777-777-7777

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

What is your race (check all that apply)? What is your race (check all that apply)?

Disabilities

Yes

Mental health diagnosis?

Yes

Have you ever been arrested or convicted of a crime?

Yes (Please explain below)

Explain your arrest and/or crime.

Do you or you family receive any of the benefits below:

Temporary Assistance for Needy Families (TANF)

Food Stamps (SNAP)

Free/Reduced Lunch

Supplemental Social Security Income (SSI)

Social Security Disability Income (SSDI)

I receive none of these benefits

Are you currently in or recently aged out of foster care?

Yes

Are you currently attending school?

Yes

No (please explain why below)

Reason why you are not currently attending school.

Current/Last School Attended:

Why do you want to register for our program?

Are you currently seeking employment opportunites?

Yes

If choosen for the program, can you commit to 6 weeks of training twice a week?

Yes

Can you provide documents to verify employment eligibilty? (Social Security Card or Passport and State Issued ID)

Yes

Have you ever worked in the food service industry?

Yes

How would you rate your cooking skills?

Beginner

Intermediate

Advanced

Select an your preferred session

June 18-20

June 25-27

Select an your preferred session

July 9-11

July 30-August 1

Your Signature

Thanks for submitting our registration form

Culinary and Leadership Academy Summer Masterclass Registration Form

As seen on

Culinary and Leadership Academy Summer Masterclass
Registration Form