Barrier and Work Readiness Questionnaire

Our advising staff is here to help you be successful. Please fill out this survey as fully and honestly as you can so we can partner with you to reach your goals.

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* 1. Full name, first and last

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* 2. Please indicate your program:

GED

Medical Administrative Assistant

Community Healthworker

Carpentry

Electrician

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* 3. Directions: Please check ALL items that apply to you in the list below.

I have reliable transportation to school and/work.

I have a back-up plan if my transportation becomes unreliable.

I have a valid driver’s license.

I have a suspended driver’s license.

I need financial help to reinstate my driver’s license.

I have a safe and secure place to live.

I have changed addresses at least twice in the last 12 months.

Within the past 12 months, I worried that my food would run out before I got money to buy more

I consider myself to be in good health.

I have one or more children living with me at least part-time.

I need help finding daycare so I can come to school/work.

I pay child support.

I have a criminal background that may or may not impact my ability to find a job.

I have a significant other and our relationship is positive.

My significant other might negatively impact my ability to be successful at school/work.

None apply to me

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* 4. Summit’s attendance policy is strictly enforced to promote the best possible learning and to mirror standards you will find in a professional work place. Do you have any upcoming commitments that might affect your attendance? (select all that apply)

child care needs

vacations or trips

court dates or other legal appointments

religious observances

medical or mental health care appointments

Other (please specify)

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* 5. Do you feel safe at home?

Yes

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* 6. I am currently:

Employed Full-Time

Employed Part-Time

Not Employed

Actively seeking Employment

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* 7. What community resources related to the above items do you need to be referred to?
Be sure to discuss these with your advisor and/or career services.

Question Title

* 1. Full name, first and last

Question Title

* 2. Please indicate your program:

Question Title

* 3. Directions: Please check ALL items that apply to you in the list below.

Question Title

* 4. Summit’s attendance policy is strictly enforced to promote the best possible learning and to mirror standards you will find in a professional work place. Do you have any upcoming commitments that might affect your attendance? (select all that apply)

Question Title

* 5. Do you feel safe at home?

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* 6. I am currently:

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* 7. What community resources related to the above items do you need to be referred to? Be sure to discuss these with your advisor and/or career services.

* 7. What community resources related to the above items do you need to be referred to?
Be sure to discuss these with your advisor and/or career services.