CT Participant Self-Assessment

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**Please be sure to use Capital Letters where appropriate.

First Name

Last Name

I attend...

I am a

Senior

Junior

Other:

Clear selection

Street Address

Unit/Apartment number

City/Town

State

Zip Code

What is the best way to contact you?

Phone

Mail

Clear selection

Phone

School Email

Personal Email

Gender

Female

Male

Clear selection

Ethnicity

African American

Asian

Caucasian

Hispanic

Native American

Other

Clear selection

If you attend a technical school what is your shop or area of study?

Reason for choosing this area of study

If you attend a public high school, have you taken any shop classes and what are they

My top career choices are (List at least one)

Age (and if under 18 - month and year I will be 18)

Safety vest size (when in doubt, size up)

Small

Medium

Large

Extra Large

2-XL

Clear selection

I have a drivers license

Yes

Clear selection

I have transportation to get to a job

Yes

Clear selection

If you are currently or have previously been employed, please tell us where you worked and the type of job you held

If you were offered a work based learning opportunity after completing this training program, would you be able to accept it?

Yes

Clear selection

If NO, why not?

I am interested in a Construction Career

Yes

Clear selection

After High School I plan to...

Reason for participating in the Pre- Apprenticeship Program

Submit

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