APPLICATION FOR SUPPORT SERVICES

If you are a young man of color, 18-28 years of age, please complete the Application for Support Services form and you will be considered for related benefits, including free job readiness training, mentoring, computer equipment, and other services, under the Priority Male Initiative.

If additional information is needed, please call 404-935-5859.

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Age *

Gender/Sex *

Female Male

Education *

Do you need a computer? *

Yes No

Do you need computer training? *

Yes No

Why do you need a computer? *

Are you interested in receiving a free laptop computer? *

Yes No

If so, are you willing to sign up for the free computer training? *

Yes No