Student Interest Survey - Fire/EMS Pathway Classes

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Todays Date *

YYYY

First Name: *

Last Name: *

Gender *

Male

Female

Transgender

Prefer not to say

Ethnicity *

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latin@

Middle Eastern

Native Hawaiian or Other Pacific Islander

White

Other:

Grade (right now) *

10th

11th

Other:

Advisory Teacher: *

What Fire/EMS pathway class are you interested in? *

Intro to Fire Science & Fire Prevention-11th and 12th grade

Emergency Medical Technician (EMT)- 12th grade only

Required

Which option best describes your interest in this class? *

I definitely want to take a Fire/EMS pathway class in the Fall

I would be interested in taking Fire/EMS pathway class in the future, just not next year

I would like to speak with someone in person about the classes

I don't want to take the class

I am interested in this class because... (select all that apply) *

I would like be a fire fighter

I would like to work on an ambulance

I would like to work in another fire or emergency response field (like 911 dispatch, fire inspector, wild land firefighter, disaster services, etc.)

I would like to work in other medical related fields (nurse, doctor, tech, etc.)

I am just curious about the topic

It looked like the most interesting elective

Im excited to take a class with Ms. Hillard

Other:

Required

What do you hope to get out of this class *

Shirt Size *

XXL

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