WorkAbility Survey
2017-2018
First name and last name
Your answer
Grade
My cell phone or home number
Your answer
Can I text you WorkAbility related information on this number?
My email (or parent's email)
Your answer
Who is my WorkAbility Employment Developer?
My School
Here's what I do in my spare time (activities, sports, special interests and hobbies):
Your answer
I have worked the following places (paid or volunteer, or helping family, etc.)
Your answer
Some directions I'm considering for after high school are:
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Required
Some careers that sound interesting to me are:
Your answer
These high school Career ROP courses sound interesting to me:
I currently work at:
(leave blank if you don't have a job right now)
Your answer
Name of supervisor:
Your answer
Phone number of employer:
Your answer
Address of employer:
Your answer
Hourly wage earned:
Your answer
While in high school I can see myself working at:
(somewhere around here, during high school)
Your answer
What I am doing right now to help me reach my goals:
(Check all that apply)
I learn best by...
(Check all that apply)
Employment Documents
(Check all that apply)
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I have a driver's license or plan to get one in high school
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If I could have ANY job in the world, I would choose to be...Dream big! This is just for fun!
Captionless Image
Your answer
My school counselor is:
My caseload (IEP) manager is:
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