* indicates a required field
First Name*
Last Name*
Address: Street*
Address: City*
Address: State*
Address: Zip Code*
Mobile Phone*
Home Phone
Work Phone
Email*
Race*American Indian or Alaskan NativeAsianBlack or African AmericanCaucasianMulti-RacialNative Hawaiian or Pacific IslanderOther
Ethnicity*HispanicNon-HispanicOther
Gender*FemaleMaleTransgenderOther
Birthdate*
Level of Education* Less Than High School GraduateHigh School Diploma / GED2 – Year CollegeBachelor’s DegreeGraduate School / Post – Secondary
Languages Spoken* Cape VerdeanEnglishFrenchGreekHaitian CreolePortugueseSpanish
How many people (including yourself) currently live in your home?(If just you, enter the number 1).*
Annual Household Income Range* $20,000 and below$20,001 to $30,000$30,001 to $40,000$40,001 to $50,000$50,001 to $60,000$60,001 to $70,000$70,001 to $80,000$80,001 to $90,000$90,001 to $100,000$100,001+
If working: What kind of work are you doing?*
If you are not working: What was the last type of work you did?*
Do you want to make green infrastructure a career?* YesNo
Are you just exploring the field of green infrastructure at this time?* YesNo
What makes you interested in taking this training in green infrastructure?*
After you complete the 35 hour green infrastructure class, do you intend to take the certification exam?* YesNo
What type of green infrastructure career would you like to pursue?* Green roof installation, maintenance, and inspectionWorking for a municipal water and sewer agencyWorking for a municipal public works agencyWorking for a municipal parks agencyWorking in the construction tradesTree planting and maintenanceRain garden, bioswale, installation, maintenance and inspectionOther
If selected Other, please specify:
Are you comfortable working outdoors under the sun and in the rain?* YesNo
Are you comfortable working in high places (ie, on a roof, etc.) with safety equipment?* YesNo
Please provide contact information for up to two (2) people you believe we should reach out to who also may be interested in Green Infrastructure Training.
Referral Name 1
Referral Email 1
Referral Phone 1
Referral Name 2
Referral Email 2
Referral Phone 2
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