First & Last Name Initial
What school do you attend?
What subject(s) do you have the most difficulty with? (i.g: Algebra 1, Intensive Reading, Physical Science, etc.) Please name all of them.
What grades would you like to achieve this year?
How can staff assist you with your educational/academic progress?
What would like to accomplish on while attending the after school program?
Do you have difficulty sitting in group settings?
Life Skills
Do you have an email address?
What is your email address?
List 3 meals you know how to cook.
Do you have a state ID?
Have you completed your 4 hour DATA/Driving course?
Have you passed your learners/drivers permit exam?
Do you have a learners permit?
Do you have a drivers license?
Do you know your address from memory?
What is your address?
Do you know your social security number from memory?
Are you registered to vote?
Do you know how to ride the bus on your own?
Do you have a resume?
Are you currently employed or have you been employed in the past?
Have you ever volunteered?
Where have you volunteered?
Do you have a bank account?
If you have a bank account, how much do you have saved? (Put NA if you dont have a bank account)
What languages do you speak?
We appreciate your participation. Look forward to us being in contact soon!
FOSTERING NEW BEGINNING