Career and Community Support Questionnaire
SBAS is dedicated to helping you with your academic and economic success, as well as your overall health and wellness. This questionnaire is to assess your needs and allow SBAS staff to better serve you.
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Email *
First Name
Last Name
What is your Date of Birth?
MM
/
DD
/
YYYY
Phone Number
What class(es) are you currently taking at South Bay Adult School?
What service(s) are you interested in?
Check all that apply
Academic Counseling
Career Pathways
Child Care
College Enrollment
Employment (seeking work)
Financial Aid
Food
Healthcare
Housing
Job Training and Information
Mental Health Services
Physical Health and Wellness
Transportation
Other
What are the best days for you to meet?
Monday
Tuesday
Wednesday
Thursday
Friday
Morning
Afternoon
Evening
Is there anything else you would like me to know about you or your current life goals?
Confidentiality Statement
The content of this survey is confidential and private. It is the policy of South Bay Adult School that employees and staff members do not disclose confidential information belonging to you or obtained through this survey. The intention of this survey is to assess the needs of SBAS students and to better offer support, care, and aide, and will only be used for this purpose.
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