Form - 2/2019
Please print clearly.
Employment Status
¨ Unemployed ¨ Employed
MA State Resident
¨ Yes ¨ No Can you Provide Citizenship/Work Authorization? ¨ Yes ¨ No
Are you currently receiving assistance?
¨ SNAP ¨ TAFDC ¨ SSI ¨ Unemployment Insurance ¨ Other:
Highest Level of Education
¨ 9
grade, no diploma ¨ High School Diploma ¨ GED/High School Equivalency ¨ Some college, no degree
¨ Associate degree:
Which training program(s) are you interested in? Please indicate order of preference if interested in more than 1 program.
¨ Certificate in Hospitality Core Skills ¨ Certificate in Culinary Core Skills
¨ Certificate in Hospitality Leadership (Rising Managers)
¨ Not receiving assistance
¨ Bachelor degree or higher:
State Zip Code
Phone/Cell Email
Certificate Courses
Hospitality Core Skills for Front-of-the-House Operations
Introduction to Hospitality
Customer Engagement
Steps of Service
Intro to Wine
Culinary Core Skills for Back-of-the-House Operations
Introduction to Hospitality
ServSafe Certification
Knife Skills
Food Prep
Hospitality Leadership (Rising Managers)
Applicants for this certificate are required to submit one (1) letter of support
along with his/her application.
Introduction to Hospitality
Customer Engagement
Business Basics for Hospitality
Hospitality Leaders
HR for Hospitality
Form - 2/2019
Are you interested in an internship opportunity? ¨ Yes ¨ No
Internship (Optional)
2-month, paid internship at a participating company
Pre-requisite is at least one of the following completed certificates:
Hospitality Core Skills
Culinary Core Skills
Please describe any prior work in the culinary or hospitality field(s):
Please describe why you are interested in this training:
How did you hear about this training?
By signing below, I am committed to finding work in either the culinary or hospitality industry, have reliable transportation,
and can commit to the entire duration of this training program.
Signature: __________________________________________________________________________ Date: __________________
If you are a person with a disability and need accommodations for this program, please contact the Disability Resource Center at
Send your completed application to Denise Johns either by email to or mail to:
Berkshire Community College, ATTN: Workforce Development, 1350 West Street, Pittsfield, MA 01201
Please call 413.236-2125 with questions.