Goodwill Industries
Program Eligibility Questionaire
Full Name
*
First Name
Last Name
Contact No.
*
-
Area Code
Phone Number
E-mail
How did you get to this form?
*
Facebook
Indeed
Google
Other
Are you over the age of 24?
*
Yes
No
Do you have a minor child in the home?
*
Yes
No
Are you lacking your GED or High School Diploma?
*
Yes
No
Are you involved with the Juvenile or Adult justice system?
*
Yes
No
Are you or have you been involved with the Foster Care System?
*
Yes
No
Are you homeless or a runaway?
*
Yes
No
Are you, your parents or guardians receiving cash benefits or PRC Funding?
*
Yes
No
Are you unemployed or underemployed?
*
Yes
No
Do you have 1 or more disabilities?
*
Yes
No
How did you learn about Goodwill's Programs?
*
OMJ Lab
Goodwill Website
Facebook
Walk in
Other Agency
School Counselor
Comments
Please verify that you are human
*
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