RAISE Your Skills ApplicationApplication to enter the RAISE program for adults with special needs. Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *Gender *MaleFemaleAddress *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? *YesNoTell 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 is able to attend the Zoom interview, willing to read and respond to weekly emails, and be available for phone calls as needed. 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 *Are 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.CommentSubmit16362