Alternate Number (where you can be reached or a message can be left)
Your answer
Best time to reach you? *
Your answer
What is the highest level of education you completed? *
Have you taken any training programs, or been to college? (For example, computers, cosmetology, cooking, etc)
Your answer
Do you have any children? *
What is your main mode of transportation? *
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Describe yourself: (For example, are you outgoing, quiet, creative, organized, curious, a go-getter?) *
Your answer
Are you currently enrolled in other reentry, skill or self-development programs? If so, please list. *
Your answer
Have you ever wanted to change anything in your community? How would you go about changing it? *
Your answer
What are the most important issues that you would like to change in your life? For example: List some things you would like to stop doing or identify some areas you would like to try doing in your life. *
Your answer
What are your immediate personal goals? (for example: obtain your GED, driver's license, obtain employment, learn a new skill, etc). Please be as specific as possible. *
Your answer
Have you ever been a leader? How? What was good about your experience? What was hard about it? *
Your answer
What are your best qualities? Please provide a thoughtful answer. *
Your answer
What do you think are the most important qualities a leader needs? Please provide a thoughtful answer. *
Your answer
What do you expect to get from the New Hour EMERGE program? *
Your answer
How did you hear about New Hour's EMERGE? *
Your answer
When did you return home? *
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Are you currently on parole or probation? *
EMERGE classes are held at our office space in Brentwood, Long Island, every Thursday from 10:30 am - 3pm for 12 weeks. Will you be able to attend all of the classes? *
Do you have reliable access to a laptop or desktop computer? *
Is there anything else about yourself that you would like to share?
Your answer
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This form was created inside of New Hour for Women and Children LI.