Student Pre-Program Survey
Program
*
Name
*
Date
*
/
Month
/
Day
Year
Date
What skills are you hoping to learn? (check as many as you want)
*
How to look for jobs
How to apply for jobs
Help to discover what I’m good at
Learn how to be a good employee
Discover what sort of work I enjoy
How to ask for accommodations at school or work
How to successfully live independently
How to utilize community resources, including community transportation
Other
Do you currently have a job? (check one)
*
Yes, I currently have a job.
I had a job, but I’m not working now.
I have filled out applications but am not working yet.
No, I’m not working now and I’m not looking for a job yet either.
How confident do you feel about getting/keeping a job? (check one)
*
I’m not ready.
Fairly confident that I will do well
I’m ready to work!
Submit
Should be Empty: