Drop Back Into School Questionaire

Drop Back Into School Questionaire

First Name:  
Last Name:Age:
Gender: Male    FemaleZip Code:
Telephone #:Alt Phone #:
Cell #:eMail:
Best time for us to contact you:
(check all that apply)
Morning (7-11am)
Noon (11am-1pm)
Afternoon (1-5pm)
Evening (5-7pm)
Late (7-10pm)
Best way to contact you:
(check all that apply)
Phone
Cell Phone
Email
Preferred Language: English
Spanish
Highlest level of education completed:
I would like to:
(check all that apply)
Improve my reading skills
Improve my math skills
Improve my computer skills
Learn or improve my English
Improve my skills to find a job
Learn life skills (Money management, etc.)
Learn a trade skill (AutoMech, Plumbing, Welding, etc)
Get my GED
Get my HS Diploma
Get my 1 year certificate (Plumbing, Child Care etc)
Get my 2yr Degree
Get my 4yr Degree
Other:
Do you need help finding Financial Aid?
Employment Status:

When are you able to attend classes?
(check all that apply)
Day
Evening
Both
Online
Obstacles that are a concern for you:
(check all that apply)
Transportation to class
Child Care during class
Housing
Prior Criminal Record
Disability
Other:
How did you learn about Drop Back In To School?
(check all that apply)
Waco ISD Website
Radio/TV
Newspaper
Flyer/Poster
Agency (Goodwill, Workforce Solutions, Christian Woman's Job Corp, etc)
Community Event
From a friend
Other
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