Google IT Support Professional Certification Application

Prepare for a Career in the Digital Workforce

Begin your future today and fill out the application below.

* Indicates required fields


Please list name, location, and dates attended

Vocational School
High School

Licenses or Certifications

Work & Volunteer History:

Starting with your most recent or current employer, assignment, or volunteer activity,

May we contact? NoYes

Skills, training, or certifications you currently hold:

Emergency Contact

Must list two


Non-family members

Additional Information:

Please answer the following questions in full and complete sentences.

I certify that all information I have provided in order to apply for the Google IT Support Professional Certificate Program Scholarship through Goodwill is true, complete, and accurate. I expressly authorize, without reservation, Goodwill, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application. I hereby waive all rights and claims I may have regarding Goodwill, its agents, employees, or representatives, for seeking, gathering, and using such information about me. I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect will be sufficient cause to 1) cancel further consideration of this application, or 2) immediately discharge me from volunteer service, whenever it is discovered.
Goodwill reserves the right to terminate the learner arrangement at any time, with or without cause or notice.