RAISE Employment ApplicationApplication to enter the RAISE program for adults with special needs. Please enable JavaScript in your browser to complete this form.FirstLastEmail *Phone *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHow should we contact you? *EmailPhoneNo preferenceAre you 18 years old or older? *YesNoAre you currently employed? *YesNoDo you want to work in the community after completing the RAISE program? *YesNoNot sureAre you currently working with Vocational Rehabilitation? *YesNoWho is your VR counselor? *Tell us about your educational background *High School DiplomaGEDSpecial High School DiplomaAdvanced Degree (college)Additional commentsHow did you hear about RAISE? *RAISE requires each applicant to have a Family Liaison, (usually a family member) who lives locally and is able to attend the interview, occasional programs, and is willing to meet for conferences if necessary.Do you have a family member willing to participate in RAISE as a Liaison? *YesNoLiaison's Name *FirstLastRelationship to Applicant *Liaison's Email *Liaison's Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeLiaison's Phone *Being a RAISE employee requires you to have transportation to work sites 3 times a week.Do you have transportation to a work site 3 times per week? *YesNoAre there any additional comments you would like to share with us? By submitting this application you grant RAISE permission to contact any persons or entities listed on your application to discuss your potential involvement in our program.PhoneSubmit