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

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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