PACE Interest Form

PACE Interest Form

Thank you for your interest in the PACE program. Please complete and submit this form and a Pathway Navigator will be in contact with you soon.

Name*
First Last
Date of Birth*
MM
DD
YYYY
Email*
Phone*
Address*
Street Address City State ZIP Code
Are you currently registered classes and/or taking classes at NIACC?*
- Yes
- No
Have you participated in NIACC’s PACE program before?*
- Yes
- No
I am interested and/or enrolled in the following training program at NIACC*
To select multiple programs, hold down the left "Ctrl" key and left click the options.
Are you currently receiving Food Assistance/SNAP?*
- Yes
- No
Preferred Method of Contact*
- Phone
- Email