Intake Form
The C.E.O. Project, Inc
Personal Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
What can the C.E.O. Project help you with? Choose all that apply.
*
Getting a full-time job
Getting a part-time job
Job training/internship/apprenticeship
Getting a high school diploma or GED
Applying to college
I am not interested in any of these.
Other, please specify
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Interests
What education/career fields are you interested in? Choose all that apply.
*
Business
STEM (Science, Technology, Engineering, and Math)
Healthcare
Education
Arts/Design/Architecture
Marketing/Communications
Social work/services
Law/Legal Services
Social Science (Psychology, Economics, Anthropology)
Trade/Vocation (Plumbing, Electrician Carpentry, Cosmetology, etc)
Other
Please list any jobs you are interested in pursuing (ex. customer service, plumber, data analyst, business administrator, programmer, entrepreneur/business owner, CNA)
Skills and Experience
Please list any previous internships, volunteer, or work experience (include dates, company names and your title)
What are some of your skills or strengths?(List any skills, hobbies, or academic strengths you believe would be valuable)
Are there any specific skills you would like to develop?(For example, communication skills, technical skills, teamwork, etc.)
Availability
How many hours per week are you available to work or attend job training?
*
Please Select
Less than 10 hours
11-20 hour
21-30 hours
30-40 hours
Please enter the days and times you are available.
*
Are you looking for in-person, remote, or hybrid job positions or education?
In-person
Remote
Hybrid (some in-person and some remote)
No preference
Additional Information
Do you have any additional preferences, goals, or concerns you would like us to know about?
How did you hear about the C.E.O. Project?
Friend/family
Church
Social media
Website
Event
Other
Notice: Completion of this form means you consent to the collection of your information to help The C.E.O. Project, Inc aid you in obtaining employment, an internship/apprenticeship, or applying to college.
*
Yes, I understand
Do you consent to have your picture taken while at events and/or workshops to be used by the C.E.O. Project for marketing and advertising purposes.
*
Yes, I consent
No, I do not consent
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Thank you and keep in touch for more!
Website
Facebook
Email: empowerment@theceoproject.info
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