Assessment of Program

Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age
Email
example@example.com
Parent Name

First NameLast Name
Parent Phone Number

Area CodePhone Number
How well can you write a resume?*

Very wellWellAveragePoorlyVery poorly
How well do you know about handling your finances?*

Very wellWellAveragePoorlyVery poorly
How well do you Network?

Very wellWellAveragePoorlyVery poorly
Would you like to attend college?

YesNo
Which do you prefer for High School Graduation

GEDHigh School DiplomaOpen to anything
Are you interested in Trade School

YesNo
DateTime
Should be Empty: