Interest Form
Please complete the form below to help us understand your interest in MERS Goodwill.
How did you hear about us?*
Word of Mouth (Family/Friends)
Another Agency

Another Goodwill Participant
Billboard

Community Event
Goodwill Employee

Goodwill Store
I am a former participant

Radio
Social Media (Facebook, Instagram, etc.)

TV
MERS Goodwill Website

How may we help you?
Education/Job Training
Help with job applications

Computer Access to apply for jobs
Help with a resume

Help with interviewing skills
Help finding job openings

Other

How can we reach you to respond to this form?
First Name and Last Name*
How should we address you?
Phone Number:*
Email:*
Please tell us a little about you. This information will help us figure out which program will be the best fit.
What's your home Zip Code:*
What is your age? (Some programs have age requirements)*
Are you currently working?*
What is your Ethnicity/Race?
Black or African American
White or Caucasian

Middle Eastern/North African
Native American

Alaskan Native
Asian

Native Hawaiian/Pacific Islander
Hispanic/LatinX

Other

We have specialized programs for people based on the items below.
Please check all that apply to you. Click here for more information about the qualifiers below.
Qualifying Disability
Court-Involved

SSI/SSDI Benefits
IEP in school

Drug/Alcohol
SNAP/Food Stamp Benefits

In Foster Care
Please share any additional information that may be helpful:

(optional) Send a copy to this email: