Enterprise LaunchPad Program-Registration Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Date of BirthGenderMaleFemaleMarital statusMailing Address (for regular correspondence): Telephone *Education level: PrimaryO-LevelA-LevelCertificateDiplomaDegeeOther (Specify)Are You currently employed?YesNo Do you have any prior vocational or business experience? YesNoIf yes, describe briefly:CaretakerWhich Enterprise Lab pathway are you applying for? Tailoring & Fashion DesignLaundry & Garment CareGrooming & CosmetologyCafé & HospitalityDigital Productivity & Workstation SkillsOther (Specify)Why do you want to join the Enterprise Launchpad Program? (Brief statement)What skills or enterprise ideas do you hope to develop?Are you available for full‑time incubation (Monday–Saturday)? YesNoHow long do you intend to stay in the program? 3 months6 months9 months12 monthsDo you require any special support (e.g., disability accommodation, flexible hours)? YesNoIf yes, specify:Do you have any health conditions FCC should be aware of? YesNoIf yes, specify:DeclarationI c e r t i f y that the i n f o r m a t i o n I have p r ov i d e d on t h i s application form is correct and completeI authorize Family Concepts Center to obtain official records from any educational institution previously attended by me, and acknowledge that Family Cocepts Center reserves the right to vary or reverse any decision regarding admission or enrolment made on the basis of incorrect or incomplete informa tionI understand that Family Concepts Center may disclose the personal information I have given in this application to the Directorate of Industrial Training Board and Ministry of Education for educational purposesFOR OFFICIAL USE ONLY (FCC STAFF) Application Received By: _____________________________________ Date: ____________________________ Interview Conducted By: ______________________________________ Interview Date: ___________________ Recommended Pathway: _______________________________________ Decision: ☐ Accepted ☐ Deferred ☐ Not Accepted Start Date: _________________________________________________ Supervisor’s Signature: ______________________________________Submit
