<img height="1" width="1" style="display:none" src="https://www.facebook.com/tr?id=1983321855463742&ev=PageView&noscript=1" />
Cybersecurity Application
Tell us about yourself
First Name
Preferred Name
Last Name
Marital Status
Please select...
Single
Married
Widow/Widower
Legally Separated
Divorced
TBD
Former Last Name
Suffix
Please select...
Jr.
Sr.
II
III
IV
Email
a space cannot be the last character
Verify Email
Street Address
City
State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip/Postal Code
Country
Please select...
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos ( Keeling ) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Côte d ' Ivoire
Croatia ( Hrvatska )
Cuba
Cyprus
Czech Republic
Congo ( DRC )
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands ( Islas Malvinas )
Faroe Islands
Fiji Islands
Finland
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia, Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Samoa
San Marino
São Tomé and Prìncipe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
St. Helena
St. Kitts and Nevis
St. Lucia
St. Pierre and Miquelon
St. Vincent and the Grenadines
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Viet Nam
Virgin Islands ( British )
Virgin Islands
Wallis and Futuna
Yemen
Zambia
Zimbabwe
Cell Phone
Cell Provider
Please select...
Not Listed
Alltel
ATT/Cingular
Bell Mobility (Canada)
Boost
Cellular One
Cricket/AIO
Fido (Canada)
Illinois Valley Cellular
Qwest
Sprint (Nextel)
Sprint PCS
SunCom
T-Mobile
Telus Mobility (Canada)
US Cellular
Verizon
Virgin Mobile
Home Phone
What is the best way to communicate with you?
Email
Phone Call
Text
Sex Assigned at Birth
Please select...
Male
Female
Pronouns
Please select...
He/Him/His
She/Her/Hers
They/Them/Theirs
She/They
He/They
Birthdate
Citizenship
Please select...
U.S.
Dual
U.S. Permanent Resident
Other
What type of United States Visa do you have? (F1, J1, etc.)
SSN
No hyphens
Are you Hispanic or Latino?
Please select...
Yes
No
Race (choose all that apply)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian/Other Pacific Islander
Hispanic or Latino
White
Prefer to not respond
Do you now, or do you plan to, work in the IT/Cybersecurity field upon completing the Cybersecurity program?
Please select...
Yes
No
Program Placement
Our Cybersecurity programs are fully self-paced. There are no live classes, no set schedule, and no pressure to be online at a certain time. You will have 4 months to complete the program. There will be an instructor available to help you with questions along the way. Does this work for you?
Please select...
Yes
No
When do you want to start the program?
Please select...
September 2025
October 2025
In regards to Information Technology, what is your knowledge/experience? Select all that apply.
No prior knowledge/experience
Self-taught (YouTube videos, webinars, etc.)
Professional Experience
Educational Background: completed course(s), certificate(s), and/or degree(s)
You indicated that you have Professional Experience in Information Technology. Please share the Job Title and time in the position.
What is a log, and how do you read it? If you do not know, type 'I do not know'.
Answer honestly, this will help determine what program you need to start in.
How would you go about triaging an alert? If you do not know, type 'I do not know'.
Answer honestly, this will help determine what program you need to start in.
Research
What is your employment status?
Please select...
Unemployed
Unemployed for more than 27 consecutive weeks
Employed
Employed, but received notice of termination of employment or military separation is pending
Underemployed: not having enough paid work or not doing work that makes full use of your skills and abilities
Not in labor force (e.g. retired, student, caretaker)
Employer
Employer County
Please select...
Bureau
Fulton
Livingston
Logan
Marshall
Mason
McLean
Peoria
Stark
Tazewell
Woodford
County Not Listed
Are you a veteran of the U.S. Armed Forces?
Please select...
Yes
No
Please select all that apply, if any
Person with a Disability
English Language Learner/Limited English Proficiency
Criminal Record (e.g. justice impacted, re-entry participants). Please note, a criminal history does not prevent participation in this program , and is only collected for the purposes of reporting.
None
Please select any benefits you are currently receiving, if any
SNAP/Food Stamps
TANF
SSI
Other form of Public Assistance
None
Highest Grade Completed
Please select...
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Highest Degree Earned
Please select...
Some high school
High School Diploma
High School Diploma Equivalency (GED, HSE)
Certificate of Attendance/Completion for successfully completing an Individualized Education Program (IEP)
Completed 1 or more years of Postsecondary Schooling
Earned a postsecondary technical or vocational certificate (non-degree)
Associate's Degree
Bachelor's Degree
Degree beyond Bachelor's
Do you have an interest in earning a bachelor's degree and would you like to receive information on Eureka College's Degree Completion Programs?
Yes
No
Are you currently enrolled at an institution (e.g. high school, trade/technical school, community college, 4-year college/university)?
Please select...
Yes, currently attending high school or less
Yes, currently attending an alternative school
Yes, currently attending community college, 4-year college/university, trade or technical school
Not attending school; high school dropout
Not attending school; high school graduate or recognized equivalent
Not attending school; within the age of compulsory school attendance
What school do you currently attend?
How did you hear about us?
Radio
Google
YouTube
LinkedIn
Facebook
Instagram
Family or Friend
Eureka College Website
IT Workforce Accelerator
Other