Google Career Certificate Scholarship Program Application

Welcome to NANBPWC, Inc and Google’s Grow with Google (GwG) initiative, which offers Google Career Certificate Scholarships. This program provides successful applicants with a Scholarship for Google Career Certificates to gain in-demand skills, with no prior experience required.

This questionnaire is only for assessment purposes, and your responses will help us better track your information and assess your suitability for the current scholarship program.

Your responses will remain confidential and will be reported only as part of the group. The results may be used for project data analysis to tailor our support to meet your needs effectively and improve future program delivery.

If you have any questions or concerns, please don’t hesitate to contact us via email at

Please note that you must be 16 years of age or older.

If you consent to participate, please begin below:

First Name

Last Name

Email Address

Phone

City

State

What is your age group? (Please check the relevant box) What is your age group? (Please check the relevant box) 16-19 20-29 30-45 46-64 65 and up

Which of the following best describes the type of school you are currently enrolled in? (Please check the relevant box) Which of the following best describes the type of school you are currently enrolled in? (Please check the relevant box) Not Enrolled High School Technical and/or vocational education University for an undergraduate degree University for a post-graduate degree

What is the highest level of education or training you have completed? (Please check the relevant box) What is the highest level of education or training you have completed? (Please check the relevant box) Not completed High school Completed High school diploma Technical and/or Vocational Diploma or Certificate Undergraduate degree Post-graduate degree Other (Please specify)

Other (Please specify)

Which of the following options best describes your work status currently? (Please check the relevant box) Which of the following options best describes your work status currently? (Please check the relevant box) Employed full-time (30 or more hrs/ week) Unemployed / Not employed yet Employed part-time (less than 30 hrs /week) Other (Please specify)

Other (Please specify)

How do you identify your gender? (Please check the relevant box) How do you identify your gender? (Please check the relevant box) Male Female Non-Binary Two-Spirit Transgender Prefer not to say Other (Please specify)

Other (Please specify)

Would you describe yourself as a person living with a disability (physical or mental)? (Please check the relevant box) Would you describe yourself as a person living with a disability (physical or mental)? (Please check the relevant box) Yes No Prefer not to say

How do you Identify yourself? (Please check the relevant box) How do you Identify yourself? (Please check the relevant box) Indigenous White Black Asian (Chinese, Korean, Japanese, Filipino etc.) West Asian (Arab, Turk, Iranian etc.) South Asian (Indian, Pakistani, Bangladesh, Sri Lanka etc.) Latin American Prefer not to say Other (Please specify)

Other (Please specify)

The Google Careers Certificate must be completed within 6 months. Do you commit to finishing the certification within the timeframe? (Please check the relevant box) The Google Careers Certificate must be completed within 6 months. Do you commit to finishing the certification within the timeframe? (Please check the relevant box) Yes No Other (please specify)

Other (please specify)

Will you have reliable access to a computer and the Internet for the duration of the program? (Please check the relevant box) Will you have reliable access to a computer and the Internet for the duration of the program? (Please check the relevant box) Yes No Other (please specify)

Other (please specify)

Have you ever participated in an online Google certificate training program? (Please check the relevant box) Have you ever participated in an online Google certificate training program? (Please check the relevant box) Yes (paid or unpaid) No Other (please specify)

Other (please specify)

Why are you interested in participating in this digital skill development program? (Please provide a maximum of THREE reasons in order of preference)

What specific skills are you hoping to develop or improve through this program? (Please indicate a maximum of THREE skills in order of preference)

What would your plans be to balance your existing commitments with participating in this program? (Please indicate a maximum of THREE plans in order of preference)

Do you hope to achieve any specific career or personal goals through this program

Is there anything else you would like us to know about you or your background that may be relevant to your application?

I confirm: I confirm: I am 16 years of age or older I have read, understood, and acknowledged the terms and conditions of this program.

4 + 3 =