Utah Uniquely Abled Machining Program
Name
First Name
Last Name
Email address
example@example.com
Phone number
Date of Birth
-
Month
-
Day
Year
Date
I identify as:
Please Select
Male
Female
BiGender
Other
Ethnicity
Please Select
African American
Asian
Caucasian
Hispanic or Latino
Mixed Ethnicity
Native American
Pacific Islander
Do not care to disclose
Resident Zip Code
Are you willing to get up and be on time for work by 9am each morning?
Please Select
Yes
No
Not Sure
How do you learn best in a classroom setting?
Please Select
seeing the information
hearing the information
hands on instruction
all of the above
none of the above
If you have had a job, tell us what you liked best about it.
Tell us if there was anything difficult for you at that job.
Do you like to work with your hands?
Please Select
Yes
No
Not sure
Have you graduated from high school or recieved your GED?
Please Select
Yes
No
Currently working on it
Can you tolerate loud noises if given ear plugs or headphones?
Please Select
Yes
No
Not Sure
Are you detail oriented or do you tend to be a perfectionist?
Please Select
Yes
No
Not sure
Do you know how to manage emotions and behaviors to avoid outbursts, running away, or actions that would put someone else in danger?
Please Select
Yes
No
Not Sure
Are you comfortable with basic math
Please Select
Yes
No
Not sure
Are you comfortable asking questions or asking others for help?
Please Select
Yes
No
What computer programs do you use?
How did you hear about this program?
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