Student Pre-Program Survey

Student Pre-Program Survey
Program*
Name*
Date*

MonthDayYear
Date
What skills are you hoping to learn? (check as many as you want)*

How to look for jobsHow to apply for jobsHelp to discover what I’m good atLearn how to be a good employeeDiscover what sort of work I enjoyHow to ask for accommodations at school or workHow to successfully live independentlyHow to utilize community resources, including community transportationOther
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 wellI’m ready to work!
Should be Empty: