Pathway to Employment Survey
How long have you been injured? *
Were you working before your injury *
Since your injury have you attempted to go back to work? *
If yes, what barriers have you experienced? *
What is your current means of income?
What is your current health insurance?
Have you considered going back to school? *
How long after your injury did you think about going back to work? *
Have you considered going back to work since your injury? *
What are some of your major concerns about returning to work?
Your answer
What can make the process of returning to work easier?
Your answer
Would you be more likely to return to work if you had a peer mentor? *
If yes how do you think you would benefit from a peer mentor?
Your answer
Would you consider going back to work if you had a packet of information explaining some of the process? *
Have you considered vocational rehabilitation? *
If yes, what was your experience with vocational rehabilitation?
Your answer
Do you have a resume? *
If no, would you be interested resume writing help?
Would you be interested in a class or webinar on interview techniques? *
Are you willing to do volunteer work? *
Do you know about reasonable accommodations? *
Are you a member of United Spinal Association? *
Would you like to become a member of United Spinal Association? *
What is your email address? *
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service