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February 22, 2012

You are here: Home / Partner / Host Participant Request Form

Host Participant Request Form

Host Company Name*
Host Company Address*
Street AddressCityStateZip Code
Twitter Handle
Please note only for business purposes, not a personal account.
Key Contact

The Key Contact is the point person from the host organization for Chicago Career Tech (CCT). The Key Contact will receive CCT Supervisor Newsletters to remain informed on all key CCT activities and timelines. This contact will also receive any communication intended for the Host Organization (i.e. Customized Training Request for Information, Invitation to CCT Launch Event, etc.)
Key Contact*
FirstLast
Key Contact Phone
Key Contact Email*
Is your organization currently an approved 501(c)(3) organization?*
- Yes
- No
How many employees work at your organization?
Is your business accessible by public transportation?*
- Yes
- No
If you are located outside of the Loop, please list your neighborhood:
Chicago Career Tech partners with TalentWise, a dominant leader in the employment screening industry, to provide background checks and drug testing for all of our Participants. The specific services provided by TalentWise are: Social Security Number (SSN) Trace, Address History Search, 7-Year County Criminal History Search, Multi-State Criminal Database Search, Nationwide Sex Offender Registry Search, and eScreen 5 Panel Urine Drug Test.
Does your organization require further screening / testing?*
- Yes
- No
If Yes, what is the lead time for this additional screening / testing?
Is the participant able to start at your organization prior to obtaining screening/testing results?
- Yes
- No
Are you able to provide your participant with a work space and computer to conduct their day-to-day operations?*
- Yes
- No
If No, please explain:
Any additional information that you wish CCT to know about your organization:
Please indicate your preference for participant placement at your organizations (please note that CCT and United Way are unable to guarantee phone screens for participants at this time):
- CCT/United Way matches a participant with my organization and provides me with participant information
- CCT/United Way provides me with two resumes to review for every spot requested so that we can provide preference
- CCT/United Way provides me with contact information for participants so that I may be able to directly contact the participant for a phone screen and provide my preference
Training Tracks Available
Listed below are the available training tracks and the approximate dates of the hands-on learning experience for each training track. Please indicate the number of Participants that you are able to host, by training track, and relevant supervisor information.
For a detailed desciption of the career training tracks click here .

If you have more than two supervisors in any track below, please email biz@chicagocareertech.com with the relevant information.
Choose Training Tracks:*
- Microsoft IT Support
- Microsoft Office Specialist
- Network Technician/CISCO
- Project Management
- SharePoint Content Management
- Mobile Application Development
- Web Design and Development
Microsoft IT Support
Projected Dates: Beginning in late May 2012, up to 24 weeks
Total # of Participants you would like to host from this track:
Supervisor Name
Supervisor Title
Supervisor Phone
Supervisor Email
Supervisor 2 Name
Supervisor 2 Title
Supervisor 2 Phone
Supervisor 2 Email
Minimum educational requirement for this position?
- High School Diploma
- Associate's Degree
- Bachelor's Degree
- No Preference
Please list any specific technical skills needed for this position:
Microsoft Office Specialist
Projected Dates: Beginning in late May 2012; up to 24 weeks
Total # of Participants you would like to host from this track:
Supervisor Name
Supervisor Title
Supervisor Phone
Supervisor Email
Supervisor 2 Name
Supervisor 2 Title
Supervisor 2 Phone
Supervisor 2 Email
Minimum educational requirement for this position?
- High School Diploma
- Associate's Degree
- Bachelor's Degree
- No Preference
Please list any specific technical skills needed for this position:
Network Technician/CISCO
Projected Dates: Beginning in late May for 24 weeks
Total # of Participants you would like to host from this track:
Supervisor Name
Supervisor Title
Supervisor Phone
Supervisor Email
Supervisor 2 Name
Supervisor 2 Title
Supervisor 2 Phone
Supervisor 2 Email
Minimum educational requirement for this position?
- High School Diploma
- Associate's Degree
- Bachelor's Degree
- No Preference
Please list any specific technical skills needed for this position:
Project Management
Projected Dates: Beginning in late May 2012; up to 21 weeks
Total # of Participants you would like to host from this track:
Supervisor Name
Supervisor Title
Supervisor Phone
Supervisor Email
Supervisor 2 Name
Supervisor 2 Title
Supervisor 2 Phone
Supervisor 2 Email
Minimum educational requirement for this position?
- High School Diploma
- Associate's Degree
- Bachelor's Degree
- No Preference
Please list any specific technical skills needed for this position:
SharePoint Content Management
Projected Dates: Beginning in late May 2012; up to 21 weeks
Total # of Participants you would like to host from this track:
Supervisor Name
Supervisor Title
Supervisor Phone
Supervisor Email
Supervisor 2 Name
Supervisor 2 Title
SUpervisor 2 Phone
Supervisor 2 Email
Minimum educational requirement for this position?
- High School Diploma
- Associate's Degree
- Bachelor's Degree
- No Preference
Please list any specific technical skills needed for this position:
Mobile Application Development
Projected Dates: Beginning in late May 2012; up to 24 weeks
Total # of Participants you would like to host from this track:
Supervisor Name
Supervisor Title
Supervisor Phone
Supervisor Email
Supervisor 2 Name
Supervisor 2 Title
Supervisor 2 Phone
Supervisor 2 Email
Minimum educational requirement for this position?
- High School Diploma
- Associate's Degree
- Bachelor's Degree
- No Preference
Please list any specific technical skills needed for this position:
Web Design and Development
Projected Dates: Beginning in late May 2012; up to 21 weeks
Total # of Participants you would like to host from this track:
Supervisor Name
Supervisor Title
Supervisor Phone
Supervisor Email
Supervisor 2 Name
Supervisor 2 Title
Supervisor 2 Phone
Supervisor 2 Email
Minimum educational requirement for this position?
- High School Diploma
- Associate's Degree
- Bachelor's Degree
- No Preference
Please list any specific technical skills needed for this position:

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