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First Name: *
Last Name: *
Email Address: *   
State: CT
Zip: *
CTHires Username:
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Disability Status: *
Gender: *
Date of Birth: *
Are you unemployed or working fewer hours due to Covid-19?: *
Unemployment Insurance status: *
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Would you like a counselor to contact you for additional assistance? Yes
Are you interested in courses such as Construction, Welding, Manufacturing, HVAC? Yes
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